| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,971 |
3,941 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,485 |
4,451 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
917 |
347 |
$104K |
| D1206 |
Topical application of fluoride varnish |
2,487 |
2,458 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,465 |
2,459 |
$54K |
| D1110 |
Prophylaxis - adult |
1,055 |
1,046 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
669 |
419 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,193 |
1,168 |
$36K |
| D1351 |
Sealant - per tooth |
1,086 |
329 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,808 |
1,792 |
$33K |
| D0330 |
Panoramic radiographic image |
569 |
567 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
559 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
138 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,117 |
1,098 |
$14K |
| D0274 |
Bitewings - four radiographic images |
500 |
498 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
636 |
566 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
253 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
41 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
31 |
$3K |
| D9248 |
|
26 |
24 |
$2K |
| D2332 |
|
25 |
15 |
$2K |