| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,794 |
2,640 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
3,235 |
3,089 |
$26K |
| D1206 |
Topical application of fluoride varnish |
3,502 |
3,306 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
674 |
278 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,589 |
1,521 |
$17K |
| D1110 |
Prophylaxis - adult |
920 |
886 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,963 |
1,856 |
$14K |
| D1351 |
Sealant - per tooth |
1,256 |
287 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,704 |
2,534 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
651 |
615 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,794 |
2,343 |
$11K |
| D0240 |
|
1,607 |
1,236 |
$10K |
| D0330 |
Panoramic radiographic image |
747 |
685 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
657 |
592 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
39 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
297 |
292 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
130 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
125 |
112 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
71 |
$547.36 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
16 |
$318.98 |