| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
885 |
858 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
819 |
792 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
686 |
664 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
564 |
539 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
145 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
119 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
329 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
216 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
73 |
$4K |
| D1354 |
|
308 |
225 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
437 |
$3K |
| D9310 |
|
120 |
111 |
$2K |
| D0272 |
Bitewings - two radiographic images |
189 |
182 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
104 |
$921.84 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$182.00 |