| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,550 |
1,506 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,937 |
1,871 |
$47K |
| D1120 |
Prophylaxis - child |
1,610 |
1,557 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
488 |
141 |
$22K |
| D9630 |
|
396 |
354 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
139 |
15 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
555 |
509 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,461 |
1,373 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
71 |
25 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
243 |
$11K |
| D1110 |
Prophylaxis - adult |
176 |
168 |
$8K |
| D0272 |
Bitewings - two radiographic images |
623 |
585 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,296 |
1,195 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
95 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$1K |
| D0274 |
Bitewings - four radiographic images |
56 |
50 |
$751.50 |