| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,119 |
2,020 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,239 |
2,127 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
600 |
313 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,347 |
1,285 |
$39K |
| D1110 |
Prophylaxis - adult |
679 |
652 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,335 |
1,285 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,273 |
1,219 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
562 |
501 |
$23K |
| D1351 |
Sealant - per tooth |
474 |
144 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
263 |
257 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
118 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
727 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
170 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
24 |
$7K |
| D0330 |
Panoramic radiographic image |
79 |
72 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
425 |
334 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
108 |
$2K |
| D9920 |
|
34 |
25 |
$0.00 |