| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
807 |
786 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
135 |
117 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
265 |
154 |
$18K |
| D1206 |
Topical application of fluoride varnish |
902 |
883 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
187 |
130 |
$11K |
| D0272 |
Bitewings - two radiographic images |
584 |
571 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
537 |
528 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
481 |
465 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
361 |
348 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
379 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
70 |
$5K |
| D0240 |
|
257 |
232 |
$5K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D1351 |
Sealant - per tooth |
24 |
13 |
$904.06 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
29 |
$333.87 |