| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,616 |
1,738 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
986 |
939 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
819 |
712 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,087 |
962 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
302 |
214 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,049 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
86 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
82 |
$11K |
| D0330 |
Panoramic radiographic image |
203 |
200 |
$10K |
| D9248 |
|
218 |
196 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
942 |
468 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
973 |
624 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
138 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
393 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
334 |
135 |
$4K |
| D1351 |
Sealant - per tooth |
109 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
72 |
72 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$1K |
| D0603 |
|
48 |
48 |
$0.00 |