| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,594 |
3,456 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,561 |
4,398 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
364 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,498 |
2,375 |
$46K |
| D1110 |
Prophylaxis - adult |
884 |
859 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
171 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,526 |
2,441 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,496 |
1,456 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
166 |
82 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
694 |
636 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
118 |
$20K |
| D1351 |
Sealant - per tooth |
453 |
122 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
183 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
299 |
$4K |
| D9110 |
|
51 |
50 |
$3K |
| D9248 |
|
14 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$996.27 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
57 |
$836.34 |