| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,528 |
3,450 |
$121K |
| D1120 |
Prophylaxis - child |
3,151 |
3,076 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,396 |
2,354 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
242 |
51 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
1,090 |
$20K |
| D0272 |
Bitewings - two radiographic images |
931 |
902 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
483 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
311 |
295 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
57 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
501 |
208 |
$8K |
| D1110 |
Prophylaxis - adult |
143 |
142 |
$7K |
| D9420 |
|
37 |
37 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
184 |
$5K |
| D1351 |
Sealant - per tooth |
79 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
44 |
44 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$682.50 |
| D9986 |
|
31 |
30 |
$0.00 |