| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
981 |
947 |
$22K |
| D1120 |
Prophylaxis - child |
504 |
489 |
$21K |
| D1206 |
Topical application of fluoride varnish |
534 |
516 |
$17K |
| D0330 |
Panoramic radiographic image |
421 |
405 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
486 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,231 |
1,177 |
$14K |
| D1351 |
Sealant - per tooth |
495 |
137 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,670 |
1,210 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
300 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
193 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
51 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
12 |
$4K |
| D8660 |
|
57 |
46 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
14 |
$969.15 |
| D0340 |
|
12 |
12 |
$516.48 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$232.32 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$223.67 |