| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,194 |
3,096 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
3,165 |
3,064 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,976 |
2,885 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
229 |
$22K |
| D0274 |
Bitewings - four radiographic images |
804 |
781 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
683 |
608 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
163 |
$13K |
| D1110 |
Prophylaxis - adult |
252 |
241 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
744 |
723 |
$11K |
| D0330 |
Panoramic radiographic image |
265 |
257 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
341 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
52 |
$9K |
| D0272 |
Bitewings - two radiographic images |
451 |
437 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
94 |
$7K |
| D1351 |
Sealant - per tooth |
256 |
102 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
132 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
224 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
15 |
$170.04 |