| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
965 |
798 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
754 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
754 |
621 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,039 |
1,024 |
$19K |
| D1354 |
|
473 |
251 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
168 |
145 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
527 |
464 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
184 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
445 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,465 |
1,205 |
$8K |
| D1351 |
Sealant - per tooth |
93 |
44 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
59 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
197 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
50 |
$2K |
| D9110 |
|
33 |
32 |
$2K |