| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,583 |
2,543 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,483 |
2,448 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,991 |
1,965 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,692 |
1,668 |
$37K |
| D1110 |
Prophylaxis - adult |
666 |
660 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,150 |
1,131 |
$30K |
| D9248 |
|
210 |
187 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
287 |
170 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
156 |
68 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
467 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
308 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
211 |
207 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
81 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
64 |
$7K |
| D1351 |
Sealant - per tooth |
299 |
82 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
411 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
71 |
$945.00 |
| D1999 |
|
213 |
189 |
$0.00 |