| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,671 |
1,561 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,915 |
1,783 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
353 |
88 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,861 |
1,731 |
$29K |
| D0272 |
Bitewings - two radiographic images |
642 |
585 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
318 |
283 |
$3K |
| D1110 |
Prophylaxis - adult |
99 |
90 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
248 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
125 |
52 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
76 |
$1K |
| D1999 |
|
108 |
107 |
$0.00 |