| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,123 |
5,093 |
$120K |
| D1206 |
Topical application of fluoride varnish |
6,552 |
6,511 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
871 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
5,538 |
5,507 |
$78K |
| D1110 |
Prophylaxis - adult |
1,523 |
1,513 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,005 |
655 |
$47K |
| D9994 |
|
6,463 |
6,421 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,624 |
1,562 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,227 |
2,214 |
$31K |
| D1351 |
Sealant - per tooth |
1,203 |
470 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
330 |
$24K |
| D9920 |
|
503 |
495 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
342 |
243 |
$19K |
| D0330 |
Panoramic radiographic image |
482 |
478 |
$18K |
| D0274 |
Bitewings - four radiographic images |
906 |
898 |
$18K |
| D0240 |
|
1,738 |
939 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
486 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
505 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
435 |
432 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
567 |
556 |
$5K |
| D9248 |
|
103 |
101 |
$4K |
| D9310 |
|
14 |
14 |
$1K |