| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,360 |
4,360 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
3,924 |
3,924 |
$135K |
| D1206 |
Topical application of fluoride varnish |
4,344 |
4,344 |
$82K |
| D0272 |
Bitewings - two radiographic images |
2,150 |
2,150 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
925 |
906 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
320 |
154 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,034 |
1,416 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,723 |
1,717 |
$29K |
| D1354 |
|
1,760 |
463 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
67 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
32 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
93 |
93 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |