| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,498 |
4,482 |
$196K |
| D1206 |
Topical application of fluoride varnish |
4,846 |
4,829 |
$149K |
| D1351 |
Sealant - per tooth |
7,391 |
1,792 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,649 |
881 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,902 |
3,887 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,670 |
1,623 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
731 |
498 |
$39K |
| D1353 |
|
4,084 |
812 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,172 |
2,164 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
679 |
678 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
3,320 |
3,304 |
$15K |
| D0603 |
|
1,673 |
1,665 |
$14K |
| D1110 |
Prophylaxis - adult |
412 |
405 |
$13K |
| D0274 |
Bitewings - four radiographic images |
935 |
929 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,070 |
3,051 |
$9K |
| D0601 |
|
674 |
674 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
29 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
49 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
67 |
$3K |
| D9920 |
|
76 |
75 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D0602 |
|
67 |
67 |
$670.00 |