| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,689 |
2,543 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,063 |
1,032 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
801 |
748 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,224 |
1,128 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,153 |
1,726 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
206 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,857 |
1,093 |
$22K |
| D0330 |
Panoramic radiographic image |
495 |
438 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,955 |
1,290 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
333 |
320 |
$13K |
| D9248 |
|
243 |
230 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
44 |
$9K |
| D1351 |
Sealant - per tooth |
247 |
71 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
533 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
38 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
147 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
24 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
78 |
77 |
$3K |
| D0274 |
Bitewings - four radiographic images |
67 |
67 |
$2K |