| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,740 |
2,619 |
$79K |
| D1206 |
Topical application of fluoride varnish |
2,784 |
2,636 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,907 |
1,834 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
162 |
89 |
$16K |
| D0272 |
Bitewings - two radiographic images |
882 |
825 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
607 |
552 |
$14K |
| D1999 |
|
603 |
457 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
542 |
441 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
501 |
485 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
210 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
59 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
331 |
305 |
$3K |
| D1351 |
Sealant - per tooth |
163 |
46 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
90 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
35 |
$798.00 |
| D1354 |
|
32 |
13 |
$460.00 |