| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,331 |
4,947 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
5,515 |
5,120 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
953 |
$103K |
| D1110 |
Prophylaxis - adult |
2,042 |
1,890 |
$87K |
| D0330 |
Panoramic radiographic image |
1,557 |
1,441 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,219 |
2,046 |
$58K |
| D1206 |
Topical application of fluoride varnish |
3,793 |
3,608 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,083 |
2,848 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
459 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,241 |
1,099 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
198 |
$8K |
| D7111 |
|
105 |
73 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
181 |
$2K |
| D9110 |
|
15 |
14 |
$630.00 |
| D1351 |
Sealant - per tooth |
42 |
13 |
$589.02 |