| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,769 |
1,758 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,607 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,234 |
1,222 |
$24K |
| D1206 |
Topical application of fluoride varnish |
843 |
840 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
518 |
452 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
454 |
450 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
129 |
103 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
280 |
279 |
$13K |
| D1110 |
Prophylaxis - adult |
256 |
251 |
$12K |
| D0272 |
Bitewings - two radiographic images |
551 |
535 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
658 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
119 |
$6K |
| D1351 |
Sealant - per tooth |
130 |
42 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
16 |
$2K |
| D0330 |
Panoramic radiographic image |
35 |
35 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$1K |