| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,275 |
3,004 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
3,100 |
2,864 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,534 |
3,247 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
630 |
359 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,767 |
1,630 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
267 |
$7K |
| D1351 |
Sealant - per tooth |
223 |
54 |
$4K |
| D0330 |
Panoramic radiographic image |
63 |
59 |
$3K |
| D0240 |
|
299 |
111 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
81 |
71 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
79 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
42 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
82 |
$453.38 |