| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,421 |
2,608 |
$75K |
| D1351 |
Sealant - per tooth |
3,916 |
694 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,361 |
2,509 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
701 |
258 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,427 |
1,719 |
$36K |
| D1110 |
Prophylaxis - adult |
1,061 |
776 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,047 |
1,486 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,023 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,895 |
1,550 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,471 |
966 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
670 |
524 |
$24K |
| D2140 |
|
612 |
296 |
$13K |
| D0274 |
Bitewings - four radiographic images |
660 |
453 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,744 |
1,230 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,472 |
936 |
$7K |
| D0330 |
Panoramic radiographic image |
443 |
295 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
13 |
$593.28 |
| D1999 |
|
722 |
365 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$0.00 |