| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
580 |
576 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
480 |
476 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
663 |
658 |
$12K |
| D0330 |
Panoramic radiographic image |
106 |
105 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
71 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
186 |
181 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
205 |
$7K |
| D1110 |
Prophylaxis - adult |
99 |
98 |
$6K |
| D1351 |
Sealant - per tooth |
232 |
61 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
70 |
$5K |
| D0272 |
Bitewings - two radiographic images |
238 |
235 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
39 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
32 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
83 |
$4K |
| D0274 |
Bitewings - four radiographic images |
67 |
67 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
140 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
26 |
$483.93 |