| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,915 |
2,886 |
$32K |
| D1206 |
Topical application of fluoride varnish |
3,831 |
3,786 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
783 |
519 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
3,322 |
3,281 |
$21K |
| D1110 |
Prophylaxis - adult |
989 |
974 |
$15K |
| D9920 |
|
403 |
394 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
945 |
908 |
$11K |
| D9994 |
|
3,914 |
3,869 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,147 |
1,139 |
$7K |
| D1351 |
Sealant - per tooth |
555 |
207 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
352 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
272 |
190 |
$6K |
| D0274 |
Bitewings - four radiographic images |
576 |
568 |
$5K |
| D0330 |
Panoramic radiographic image |
243 |
237 |
$4K |
| D0240 |
|
669 |
361 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
202 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
263 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
177 |
173 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
68 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
346 |
$1K |
| D9248 |
|
32 |
31 |
$0.00 |