| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,334 |
4,312 |
$151K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,374 |
483 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
4,869 |
4,838 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,705 |
2,681 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,640 |
2,628 |
$58K |
| D1110 |
Prophylaxis - adult |
1,120 |
1,107 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
783 |
524 |
$47K |
| D1351 |
Sealant - per tooth |
1,323 |
413 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,400 |
1,374 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,946 |
1,937 |
$35K |
| D0330 |
Panoramic radiographic image |
682 |
672 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
212 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,510 |
1,480 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
598 |
594 |
$18K |
| D0274 |
Bitewings - four radiographic images |
536 |
529 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
391 |
387 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
826 |
715 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D9248 |
|
12 |
12 |
$1K |