| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,109 |
1,007 |
$60K |
| D1120 |
Prophylaxis - child |
1,259 |
1,219 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,198 |
1,163 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
171 |
131 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
678 |
666 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
421 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
112 |
$10K |
| D1351 |
Sealant - per tooth |
173 |
92 |
$8K |
| D0272 |
Bitewings - two radiographic images |
698 |
660 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
789 |
748 |
$5K |
| D0330 |
Panoramic radiographic image |
116 |
108 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
432 |
417 |
$2K |
| D2140 |
|
44 |
30 |
$2K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$438.68 |
| D1999 |
|
23 |
21 |
$0.00 |