| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,146 |
2,127 |
$73K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
435 |
288 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,823 |
1,806 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
843 |
756 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,143 |
1,132 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
677 |
663 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,233 |
1,223 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
328 |
328 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
132 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
925 |
900 |
$13K |
| D0272 |
Bitewings - two radiographic images |
569 |
557 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
224 |
$10K |
| D1351 |
Sealant - per tooth |
357 |
119 |
$9K |
| D0330 |
Panoramic radiographic image |
156 |
153 |
$8K |
| D1110 |
Prophylaxis - adult |
116 |
114 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
51 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$3K |