| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,080 |
2,080 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,548 |
2,548 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,072 |
3,070 |
$50K |
| D1110 |
Prophylaxis - adult |
965 |
963 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,475 |
2,473 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
328 |
187 |
$34K |
| D9248 |
|
454 |
396 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
767 |
692 |
$25K |
| D0240 |
|
438 |
233 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
99 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
26 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$900.00 |