| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,319 |
1,293 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,283 |
1,268 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,457 |
1,432 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
152 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
413 |
352 |
$8K |
| D0272 |
Bitewings - two radiographic images |
744 |
728 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
103 |
$7K |
| D1351 |
Sealant - per tooth |
563 |
179 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
568 |
548 |
$4K |
| D0274 |
Bitewings - four radiographic images |
268 |
268 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
532 |
402 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
117 |
$3K |
| D1110 |
Prophylaxis - adult |
124 |
124 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$753.44 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$188.88 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
24 |
$175.05 |
| D0603 |
|
315 |
312 |
$0.00 |