| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
462 |
440 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
554 |
$13K |
| D0272 |
Bitewings - two radiographic images |
503 |
480 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
78 |
57 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
538 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
86 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
170 |
130 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
767 |
429 |
$6K |
| D0330 |
Panoramic radiographic image |
146 |
134 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
495 |
468 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
74 |
55 |
$5K |
| D1110 |
Prophylaxis - adult |
94 |
91 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
41 |
$3K |