| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,878 |
7,855 |
$351K |
| D0120 |
Periodic oral evaluation - established patient |
6,743 |
6,721 |
$229K |
| D1206 |
Topical application of fluoride varnish |
7,936 |
7,911 |
$223K |
| D1351 |
Sealant - per tooth |
2,912 |
1,090 |
$113K |
| D0330 |
Panoramic radiographic image |
772 |
771 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
983 |
980 |
$62K |
| D0272 |
Bitewings - two radiographic images |
1,966 |
1,961 |
$61K |
| D0240 |
|
758 |
753 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
30 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
154 |
133 |
$9K |
| D0274 |
Bitewings - four radiographic images |
168 |
168 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
404 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
151 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
25 |
$4K |