| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,314 |
2,301 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
1,189 |
1,182 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,099 |
750 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
731 |
731 |
$48K |
| D1310 |
|
1,008 |
999 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,303 |
2,290 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
319 |
$33K |
| D9993 |
|
531 |
531 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
703 |
635 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,713 |
1,658 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
175 |
$14K |
| D0350 |
|
1,481 |
851 |
$14K |
| D0603 |
|
691 |
684 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
834 |
802 |
$9K |
| D0274 |
Bitewings - four radiographic images |
194 |
194 |
$4K |
| D0272 |
Bitewings - two radiographic images |
284 |
284 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
14 |
$3K |
| D9430 |
|
12 |
12 |
$384.00 |