| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,275 |
3,086 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,193 |
3,949 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
3,590 |
3,395 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
974 |
549 |
$47K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
386 |
223 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,228 |
2,090 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,448 |
1,110 |
$32K |
| D1110 |
Prophylaxis - adult |
964 |
896 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
774 |
705 |
$17K |
| D1351 |
Sealant - per tooth |
704 |
271 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
167 |
$14K |
| D9248 |
|
440 |
305 |
$11K |
| D0330 |
Panoramic radiographic image |
162 |
152 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
83 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
838 |
674 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
517 |
$5K |
| D2140 |
|
84 |
54 |
$4K |
| D9920 |
|
73 |
53 |
$374.00 |