| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
876 |
778 |
$34K |
| D1206 |
Topical application of fluoride varnish |
850 |
756 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
445 |
$14K |
| D0272 |
Bitewings - two radiographic images |
676 |
594 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
434 |
383 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
120 |
15 |
$5K |
| D0330 |
Panoramic radiographic image |
58 |
54 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
29 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
126 |
94 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$861.00 |
| D1351 |
Sealant - per tooth |
48 |
12 |
$730.67 |
| D1354 |
|
139 |
15 |
$651.90 |
| D9420 |
|
19 |
12 |
$491.88 |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
31 |
$322.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
15 |
$76.57 |