| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,726 |
1,688 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,997 |
1,907 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,250 |
2,226 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
275 |
$31K |
| D1110 |
Prophylaxis - adult |
667 |
630 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
312 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,223 |
1,145 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
747 |
725 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
303 |
$16K |
| D1351 |
Sealant - per tooth |
660 |
233 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
370 |
370 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
14 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
26 |
$6K |
| D0274 |
Bitewings - four radiographic images |
301 |
301 |
$6K |
| D0330 |
Panoramic radiographic image |
412 |
412 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
199 |
146 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
291 |
283 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
67 |
$2K |
| D0603 |
|
320 |
256 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$752.36 |
| D9420 |
|
13 |
13 |
$558.74 |
| D9310 |
|
14 |
14 |
$376.18 |
| D0602 |
|
71 |
63 |
$355.00 |