| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
509 |
484 |
$22K |
| D1206 |
Topical application of fluoride varnish |
592 |
563 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
333 |
317 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
12 |
$8K |
| D0272 |
Bitewings - two radiographic images |
239 |
221 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
79 |
$5K |
| D0240 |
|
369 |
137 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
244 |
232 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
65 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$717.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
28 |
$403.20 |