| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
343 |
330 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
112 |
73 |
$10K |
| D1206 |
Topical application of fluoride varnish |
323 |
311 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
270 |
262 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
162 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
46 |
$3K |
| D0272 |
Bitewings - two radiographic images |
224 |
214 |
$2K |
| D2140 |
|
41 |
33 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
68 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
19 |
$1K |
| D0274 |
Bitewings - four radiographic images |
58 |
55 |
$876.90 |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
158 |
$810.10 |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
36 |
$697.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
116 |
$484.40 |
| D0330 |
Panoramic radiographic image |
17 |
16 |
$339.00 |