| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,056 |
1,723 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,860 |
1,566 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
143 |
$38K |
| D1310 |
|
811 |
681 |
$24K |
| D9630 |
|
1,833 |
1,554 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,345 |
1,130 |
$21K |
| D0603 |
|
2,439 |
2,050 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
583 |
434 |
$17K |
| D1330 |
|
813 |
683 |
$14K |
| D1110 |
Prophylaxis - adult |
290 |
253 |
$13K |
| D0272 |
Bitewings - two radiographic images |
628 |
511 |
$12K |
| D1206 |
Topical application of fluoride varnish |
640 |
542 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
72 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
626 |
528 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
32 |
$8K |
| D0330 |
Panoramic radiographic image |
173 |
147 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
150 |
$7K |
| D1351 |
Sealant - per tooth |
332 |
72 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
177 |
146 |
$6K |
| D0425 |
|
145 |
118 |
$6K |
| D0274 |
Bitewings - four radiographic images |
161 |
134 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
415 |
169 |
$4K |
| D0240 |
|
141 |
119 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
77 |
$3K |
| D0010 |
|
29 |
26 |
$0.00 |
| D4999 |
|
51 |
45 |
$0.00 |