| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,227 |
10,014 |
$309K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,980 |
999 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
11,598 |
9,482 |
$260K |
| D1206 |
Topical application of fluoride varnish |
11,949 |
9,499 |
$242K |
| D0272 |
Bitewings - two radiographic images |
5,983 |
4,745 |
$98K |
| D0330 |
Panoramic radiographic image |
2,155 |
1,646 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,229 |
439 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,223 |
2,876 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,639 |
1,284 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,096 |
1,545 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,469 |
1,161 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,308 |
983 |
$40K |
| D0274 |
Bitewings - four radiographic images |
923 |
723 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
923 |
707 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
962 |
286 |
$6K |
| D9310 |
|
245 |
104 |
$4K |
| D1110 |
Prophylaxis - adult |
75 |
57 |
$3K |
| D9420 |
|
87 |
27 |
$1K |
| D0350 |
|
124 |
55 |
$854.99 |
| D1999 |
|
1,138 |
1,091 |
$0.00 |
| D1354 |
|
513 |
170 |
$0.00 |