| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,089 |
2,050 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,461 |
2,410 |
$60K |
| D0240 |
|
2,278 |
1,145 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,092 |
2,054 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,458 |
1,429 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
241 |
67 |
$29K |
| D1110 |
Prophylaxis - adult |
370 |
358 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
678 |
608 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
410 |
393 |
$12K |
| D0330 |
Panoramic radiographic image |
131 |
124 |
$7K |
| D1351 |
Sealant - per tooth |
267 |
79 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
40 |
$5K |
| D0603 |
|
1,177 |
1,147 |
$5K |