| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
206 |
197 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
15 |
$6K |
| D1206 |
Topical application of fluoride varnish |
253 |
244 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
21 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
184 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
143 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
88 |
85 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
42 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
120 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
47 |
$2K |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$1K |
| D3120 |
|
30 |
15 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
19 |
$767.82 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
13 |
$471.37 |