| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,368 |
2,849 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,279 |
3,691 |
$67K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
541 |
265 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,523 |
2,974 |
$54K |
| D1351 |
Sealant - per tooth |
2,995 |
564 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,045 |
596 |
$49K |
| D1110 |
Prophylaxis - adult |
1,407 |
1,232 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,036 |
1,434 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
677 |
349 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,465 |
1,255 |
$24K |
| D2140 |
|
630 |
423 |
$22K |
| D0274 |
Bitewings - four radiographic images |
651 |
564 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
706 |
622 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
331 |
240 |
$8K |
| D0330 |
Panoramic radiographic image |
199 |
169 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
687 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
83 |
$3K |
| D0160 |
|
16 |
15 |
$700.00 |
| D0240 |
|
24 |
12 |
$444.00 |