| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,849 |
1,716 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,725 |
1,623 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,274 |
2,055 |
$26K |
| D0272 |
Bitewings - two radiographic images |
995 |
940 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
14 |
$4K |
| D1351 |
Sealant - per tooth |
121 |
49 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
83 |
$2K |
| D0240 |
|
182 |
94 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$908.94 |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
112 |
$846.92 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$802.18 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$525.20 |