| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,803 |
1,654 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,518 |
1,407 |
$28K |
| D1206 |
Topical application of fluoride varnish |
2,083 |
1,873 |
$23K |
| D0272 |
Bitewings - two radiographic images |
971 |
887 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
127 |
40 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
141 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
148 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
39 |
$2K |
| D1351 |
Sealant - per tooth |
104 |
41 |
$2K |
| D0240 |
|
246 |
127 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$666.35 |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
65 |
$555.64 |