| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,765 |
1,695 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,171 |
2,086 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,484 |
2,398 |
$62K |
| D1110 |
Prophylaxis - adult |
962 |
921 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
980 |
868 |
$42K |
| D0272 |
Bitewings - two radiographic images |
665 |
631 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
387 |
$17K |
| D0274 |
Bitewings - four radiographic images |
300 |
282 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
596 |
574 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
24 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
14 |
$4K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
52 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
115 |
$2K |
| D0240 |
|
43 |
43 |
$1K |