| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,027 |
2,001 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,893 |
1,869 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,065 |
1,040 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
500 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
440 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
841 |
823 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
179 |
162 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
16 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
580 |
142 |
$7K |
| D0272 |
Bitewings - two radiographic images |
200 |
199 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$2K |