| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,168 |
1,911 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,121 |
1,858 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
325 |
276 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
246 |
72 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,300 |
2,003 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,292 |
1,147 |
$27K |
| D1351 |
Sealant - per tooth |
293 |
48 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
111 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
231 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
266 |
208 |
$2K |
| D1110 |
Prophylaxis - adult |
65 |
31 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
51 |
$1K |
| D0274 |
Bitewings - four radiographic images |
85 |
45 |
$1K |
| D0602 |
|
924 |
806 |
$0.00 |
| D0601 |
|
1,592 |
1,400 |
$0.00 |
| D0603 |
|
259 |
214 |
$0.00 |