| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,354 |
4,240 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
4,397 |
4,283 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,607 |
4,488 |
$75K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
452 |
210 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,595 |
1,551 |
$30K |
| D1351 |
Sealant - per tooth |
1,271 |
322 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
399 |
261 |
$28K |
| D1110 |
Prophylaxis - adult |
508 |
498 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,113 |
1,046 |
$19K |
| D0330 |
Panoramic radiographic image |
240 |
238 |
$12K |
| D2140 |
|
215 |
156 |
$12K |
| D0274 |
Bitewings - four radiographic images |
428 |
413 |
$12K |
| D0240 |
|
635 |
391 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
287 |
279 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
142 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
24 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
62 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$627.47 |