| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,897 |
1,799 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,760 |
1,684 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,410 |
2,217 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,080 |
1,019 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
27 |
$5K |
| D0240 |
|
337 |
190 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
14 |
$3K |
| D1351 |
Sealant - per tooth |
102 |
37 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
68 |
65 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
37 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
15 |
$921.17 |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
84 |
$727.57 |