| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,286 |
7,151 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
7,175 |
7,054 |
$174K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,547 |
537 |
$161K |
| D1206 |
Topical application of fluoride varnish |
7,725 |
7,590 |
$154K |
| D0272 |
Bitewings - two radiographic images |
2,763 |
2,711 |
$59K |
| D1110 |
Prophylaxis - adult |
667 |
655 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
396 |
$12K |
| D0274 |
Bitewings - four radiographic images |
262 |
261 |
$8K |
| D1354 |
|
1,056 |
276 |
$7K |
| D1351 |
Sealant - per tooth |
279 |
70 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
24 |
$4K |
| D9310 |
|
118 |
110 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
123 |
$879.04 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$629.94 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
36 |
$564.36 |
| D9420 |
|
13 |
12 |
$495.33 |
| D0240 |
|
29 |
13 |
$67.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
13 |
$54.00 |
| D1999 |
|
237 |
228 |
$0.00 |