| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,541 |
1,538 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,253 |
1,252 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,451 |
1,448 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
254 |
65 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,444 |
371 |
$14K |
| D0272 |
Bitewings - two radiographic images |
626 |
625 |
$13K |
| D0603 |
|
1,488 |
1,483 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
519 |
508 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
220 |
$6K |
| D0240 |
|
350 |
229 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
126 |
$5K |
| D1351 |
Sealant - per tooth |
106 |
37 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
96 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
56 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
33 |
$1K |
| D1354 |
|
527 |
178 |
$1K |