| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,193 |
2,159 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,756 |
2,714 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,738 |
2,698 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,196 |
1,179 |
$21K |
| D1110 |
Prophylaxis - adult |
443 |
437 |
$17K |
| D0330 |
Panoramic radiographic image |
258 |
252 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
87 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
114 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
439 |
421 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
55 |
$5K |
| D1351 |
Sealant - per tooth |
208 |
57 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
166 |
$3K |
| D1206 |
Topical application of fluoride varnish |
173 |
172 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
49 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D2140 |
|
20 |
19 |
$921.00 |