| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,470 |
1,339 |
$76K |
| D1120 |
Prophylaxis - child |
1,795 |
1,764 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
353 |
216 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,660 |
1,639 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
436 |
281 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
971 |
959 |
$27K |
| D1351 |
Sealant - per tooth |
532 |
257 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
772 |
761 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
1,017 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,189 |
1,139 |
$7K |
| D0330 |
Panoramic radiographic image |
266 |
266 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
805 |
764 |
$4K |
| D2140 |
|
55 |
41 |
$2K |
| D0274 |
Bitewings - four radiographic images |
65 |
65 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$253.37 |
| D1999 |
|
16 |
15 |
$0.00 |