| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,139 |
3,118 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,846 |
2,845 |
$66K |
| D1110 |
Prophylaxis - adult |
772 |
771 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
117 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,800 |
1,767 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
231 |
89 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,347 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,282 |
1,282 |
$27K |
| D1351 |
Sealant - per tooth |
699 |
214 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
768 |
755 |
$24K |
| D0350 |
|
581 |
426 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,547 |
1,541 |
$19K |
| D0240 |
|
947 |
946 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
415 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
231 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
611 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
59 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
60 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
147 |
147 |
$5K |
| D0274 |
Bitewings - four radiographic images |
116 |
116 |
$3K |
| D9219 |
|
42 |
42 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$893.35 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$426.53 |