| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,805 |
2,754 |
$121K |
| D1206 |
Topical application of fluoride varnish |
2,851 |
2,793 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
932 |
368 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,409 |
1,396 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
842 |
404 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,807 |
1,742 |
$30K |
| D1351 |
Sealant - per tooth |
1,426 |
373 |
$28K |
| D2140 |
|
630 |
358 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,218 |
1,184 |
$26K |
| D9248 |
|
283 |
247 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
592 |
570 |
$19K |
| D0330 |
Panoramic radiographic image |
459 |
448 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
544 |
267 |
$18K |
| D2933 |
|
147 |
47 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
990 |
893 |
$13K |
| D0603 |
|
2,712 |
2,670 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
596 |
551 |
$7K |
| D0274 |
Bitewings - four radiographic images |
275 |
270 |
$6K |
| D0240 |
|
253 |
232 |
$3K |
| D9420 |
|
58 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
180 |
$1K |
| D0601 |
|
19 |
18 |
$90.00 |
| D9215 |
|
169 |
162 |
$24.60 |