| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,678 |
3,497 |
$154K |
| D1351 |
Sealant - per tooth |
2,169 |
952 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,823 |
2,670 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,563 |
1,412 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,086 |
1,997 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,631 |
1,557 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
318 |
252 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
1,310 |
$34K |
| D0330 |
Panoramic radiographic image |
643 |
632 |
$26K |
| D0274 |
Bitewings - four radiographic images |
886 |
849 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,689 |
1,618 |
$19K |
| D2140 |
|
409 |
330 |
$16K |
| D1110 |
Prophylaxis - adult |
291 |
280 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,525 |
1,469 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,041 |
799 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
92 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
29 |
$2K |
| D1999 |
|
75 |
70 |
$0.00 |