| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
8,819 |
8,602 |
$216K |
| D1120 |
Prophylaxis - child |
6,548 |
6,535 |
$184K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,507 |
688 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
7,449 |
7,431 |
$178K |
| D1351 |
Sealant - per tooth |
2,175 |
637 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
891 |
593 |
$53K |
| D1110 |
Prophylaxis - adult |
1,489 |
1,481 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
765 |
498 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,347 |
3,338 |
$47K |
| D1999 |
|
4,330 |
4,076 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
66 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
309 |
245 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,360 |
$9K |
| D0274 |
Bitewings - four radiographic images |
383 |
381 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
291 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
837 |
605 |
$4K |
| D0240 |
|
509 |
285 |
$4K |
| D2332 |
|
37 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
60 |
60 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$1K |