| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,054 |
3,005 |
$148K |
| D1206 |
Topical application of fluoride varnish |
2,954 |
2,907 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,111 |
2,084 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,888 |
1,854 |
$67K |
| D1351 |
Sealant - per tooth |
1,713 |
525 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
410 |
294 |
$61K |
| D0330 |
Panoramic radiographic image |
669 |
664 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
748 |
737 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
844 |
768 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
146 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
370 |
369 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
64 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
77 |
$11K |
| D1354 |
|
156 |
51 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
177 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
49 |
$2K |
| D0240 |
|
13 |
13 |
$518.00 |