| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,999 |
1,880 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,169 |
1,148 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,704 |
1,656 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
253 |
76 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,029 |
848 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,008 |
971 |
$16K |
| D0330 |
Panoramic radiographic image |
365 |
345 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
330 |
310 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
881 |
771 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
168 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
164 |
149 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$2K |
| D0274 |
Bitewings - four radiographic images |
71 |
70 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
123 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
82 |
$1K |
| D9310 |
|
13 |
12 |
$423.04 |
| D1999 |
|
854 |
829 |
$0.00 |