| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
985 |
982 |
$39K |
| D8660 |
|
78 |
78 |
$24K |
| D1206 |
Topical application of fluoride varnish |
971 |
966 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
521 |
519 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
380 |
$14K |
| D0272 |
Bitewings - two radiographic images |
576 |
574 |
$11K |
| D0340 |
|
77 |
77 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
14 |
$6K |
| D0240 |
|
390 |
210 |
$6K |
| D0603 |
|
553 |
552 |
$4K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
102 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
265 |
$3K |
| D0601 |
|
356 |
355 |
$3K |
| D9920 |
|
431 |
423 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
67 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
44 |
$792.00 |
| D1310 |
|
981 |
977 |
$10.00 |
| D1330 |
|
981 |
978 |
$10.00 |
| D9986 |
|
14 |
12 |
$0.00 |
| D0350 |
|
13 |
13 |
$0.00 |
| D0470 |
|
74 |
74 |
$0.00 |