| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,357 |
13,164 |
$666K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,803 |
14,495 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
13,145 |
12,946 |
$372K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,785 |
772 |
$160K |
| D0274 |
Bitewings - four radiographic images |
2,985 |
2,950 |
$126K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
571 |
175 |
$110K |
| D1351 |
Sealant - per tooth |
2,839 |
852 |
$110K |
| D1206 |
Topical application of fluoride varnish |
4,104 |
4,072 |
$100K |
| D0272 |
Bitewings - two radiographic images |
2,691 |
2,648 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,261 |
1,246 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,144 |
3,039 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
572 |
271 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,504 |
2,234 |
$50K |
| D9450 |
|
1,595 |
1,453 |
$43K |
| D1110 |
Prophylaxis - adult |
481 |
473 |
$32K |
| D0330 |
Panoramic radiographic image |
350 |
340 |
$29K |
| D1354 |
|
1,703 |
360 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
466 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
758 |
455 |
$10K |
| D0603 |
|
6,079 |
5,983 |
$0.00 |
| D1999 |
|
403 |
385 |
$0.00 |