| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,421 |
6,336 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
8,825 |
8,700 |
$163K |
| D1206 |
Topical application of fluoride varnish |
9,444 |
9,281 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,391 |
2,312 |
$112K |
| D1110 |
Prophylaxis - adult |
2,956 |
2,921 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,130 |
776 |
$93K |
| D0272 |
Bitewings - two radiographic images |
4,070 |
4,002 |
$66K |
| D1351 |
Sealant - per tooth |
1,890 |
569 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
571 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
479 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
775 |
752 |
$19K |
| D0240 |
|
734 |
443 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
47 |
12 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
63 |
$7K |
| D0274 |
Bitewings - four radiographic images |
157 |
157 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
102 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$238.46 |