| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,327 |
1,312 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
158 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
750 |
741 |
$41K |
| D1206 |
Topical application of fluoride varnish |
948 |
936 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
90 |
$21K |
| D1351 |
Sealant - per tooth |
381 |
127 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
304 |
303 |
$13K |
| D0272 |
Bitewings - two radiographic images |
479 |
476 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
202 |
$12K |
| D0240 |
|
432 |
233 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
308 |
306 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
13 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
312 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
105 |
$4K |
| D9310 |
|
34 |
26 |
$4K |
| D0603 |
|
344 |
321 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
237 |
161 |
$2K |
| D0170 |
|
42 |
42 |
$2K |
| D0601 |
|
126 |
123 |
$1K |
| D1330 |
|
703 |
698 |
$1K |
| D0602 |
|
30 |
28 |
$308.00 |
| D9990 |
|
12 |
12 |
$38.00 |
| D9912 |
|
24 |
23 |
$8.00 |