| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,297 |
3,235 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,116 |
613 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,644 |
3,572 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,429 |
4,345 |
$69K |
| D1110 |
Prophylaxis - adult |
1,278 |
1,252 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,196 |
1,979 |
$60K |
| D1351 |
Sealant - per tooth |
1,878 |
390 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
391 |
281 |
$42K |
| D0330 |
Panoramic radiographic image |
707 |
692 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
226 |
107 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
751 |
723 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
421 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
164 |
$19K |
| D1354 |
|
370 |
113 |
$9K |
| D0272 |
Bitewings - two radiographic images |
419 |
411 |
$9K |
| D8660 |
|
172 |
169 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
401 |
334 |
$5K |
| D3120 |
|
93 |
75 |
$2K |
| D0170 |
|
57 |
55 |
$1K |