| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
3,486 |
2,685 |
$64K |
| D1120 |
Prophylaxis - child |
1,997 |
1,914 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
353 |
$42K |
| D0330 |
Panoramic radiographic image |
1,096 |
1,024 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
644 |
452 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,948 |
2,789 |
$41K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
390 |
226 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
718 |
400 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,747 |
1,318 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,477 |
1,378 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,312 |
1,244 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,161 |
1,130 |
$22K |
| D1351 |
Sealant - per tooth |
711 |
183 |
$16K |
| D1110 |
Prophylaxis - adult |
401 |
378 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
452 |
415 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
289 |
271 |
$7K |
| D0274 |
Bitewings - four radiographic images |
213 |
197 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
317 |
294 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$126.00 |