| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,074 |
2,557 |
$111K |
| D1206 |
Topical application of fluoride varnish |
2,826 |
2,379 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
956 |
408 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,368 |
1,198 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
638 |
288 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,891 |
1,592 |
$28K |
| D1351 |
Sealant - per tooth |
1,562 |
452 |
$27K |
| D2140 |
|
594 |
286 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,185 |
1,003 |
$21K |
| D0330 |
Panoramic radiographic image |
511 |
424 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
543 |
263 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,130 |
939 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
649 |
449 |
$14K |
| D9248 |
|
216 |
169 |
$14K |
| D0274 |
Bitewings - four radiographic images |
339 |
283 |
$6K |
| D0603 |
|
2,081 |
1,755 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
372 |
$4K |
| D0240 |
|
199 |
158 |
$2K |
| D0601 |
|
656 |
562 |
$2K |
| D3120 |
|
16 |
13 |
$198.00 |