| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
667 |
636 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
554 |
533 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
616 |
586 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
12 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
51 |
$8K |
| D0272 |
Bitewings - two radiographic images |
276 |
267 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
48 |
$2K |
| D9420 |
|
12 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
79 |
$954.94 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$581.88 |
| D9248 |
|
13 |
13 |
$0.00 |