| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,216 |
9,743 |
$294K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,032 |
572 |
$253K |
| D1206 |
Topical application of fluoride varnish |
11,458 |
10,968 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
11,149 |
10,690 |
$211K |
| D0272 |
Bitewings - two radiographic images |
4,156 |
3,975 |
$85K |
| D1110 |
Prophylaxis - adult |
1,865 |
1,826 |
$69K |
| D0330 |
Panoramic radiographic image |
1,109 |
1,065 |
$58K |
| D1351 |
Sealant - per tooth |
1,702 |
325 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,316 |
1,183 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
756 |
703 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
112 |
$14K |
| D0240 |
|
837 |
377 |
$13K |
| D9920 |
|
254 |
219 |
$10K |
| D0274 |
Bitewings - four radiographic images |
153 |
149 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
28 |
$265.00 |
| D1330 |
|
9,551 |
9,295 |
$0.00 |
| D0601 |
|
304 |
288 |
$0.00 |
| D1310 |
|
9,562 |
9,306 |
$0.00 |
| D0603 |
|
809 |
757 |
$0.00 |
| D0602 |
|
98 |
92 |
$0.00 |