| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
795 |
791 |
$27K |
| D1206 |
Topical application of fluoride varnish |
935 |
929 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
478 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
457 |
457 |
$11K |
| D0330 |
Panoramic radiographic image |
313 |
309 |
$10K |
| D1110 |
Prophylaxis - adult |
185 |
181 |
$7K |
| D0272 |
Bitewings - two radiographic images |
338 |
337 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
13 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
84 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
209 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
70 |
$2K |
| D9248 |
|
17 |
17 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
136 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$557.18 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$261.10 |