| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,949 |
6,814 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
6,113 |
6,005 |
$202K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
750 |
294 |
$143K |
| D1206 |
Topical application of fluoride varnish |
4,688 |
4,599 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,081 |
1,701 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,132 |
716 |
$110K |
| D0272 |
Bitewings - two radiographic images |
2,418 |
2,377 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,178 |
2,142 |
$60K |
| D1351 |
Sealant - per tooth |
1,353 |
402 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
204 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
591 |
$37K |
| D0330 |
Panoramic radiographic image |
298 |
285 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
679 |
651 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
163 |
$4K |
| D0274 |
Bitewings - four radiographic images |
50 |
48 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
41 |
$2K |