| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,769 |
1,650 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,260 |
1,157 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
347 |
279 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,040 |
911 |
$26K |
| D1206 |
Topical application of fluoride varnish |
923 |
861 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
652 |
$17K |
| D1351 |
Sealant - per tooth |
292 |
159 |
$16K |
| D2140 |
|
333 |
280 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
580 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
147 |
$8K |
| D0272 |
Bitewings - two radiographic images |
927 |
877 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
99 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
282 |
268 |
$6K |
| D0274 |
Bitewings - four radiographic images |
316 |
290 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
570 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
497 |
446 |
$2K |
| D0330 |
Panoramic radiographic image |
156 |
147 |
$2K |
| D1999 |
|
234 |
189 |
$0.00 |