| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,381 |
3,310 |
$44K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
506 |
122 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,748 |
2,684 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,330 |
2,294 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,753 |
1,704 |
$12K |
| D1351 |
Sealant - per tooth |
1,320 |
360 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
560 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,555 |
1,510 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
611 |
557 |
$6K |
| D1354 |
|
659 |
177 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
844 |
$4K |
| D1110 |
Prophylaxis - adult |
234 |
229 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
53 |
$3K |
| D0240 |
|
690 |
470 |
$3K |
| D0274 |
Bitewings - four radiographic images |
195 |
194 |
$2K |
| D0330 |
Panoramic radiographic image |
120 |
115 |
$2K |
| D9310 |
|
57 |
57 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$407.54 |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
42 |
$121.43 |
| D0603 |
|
2,154 |
2,060 |
$0.00 |
| D0602 |
|
46 |
46 |
$0.00 |
| D1330 |
|
305 |
300 |
$0.00 |
| D1310 |
|
302 |
298 |
$0.00 |
| D0190 |
|
451 |
446 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
126 |
120 |
$0.00 |
| D1999 |
|
141 |
138 |
$0.00 |