| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,407 |
5,128 |
$208K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
454 |
315 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,175 |
1,134 |
$56K |
| D1110 |
Prophylaxis - adult |
935 |
906 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
691 |
428 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
5,491 |
5,218 |
$33K |
| D0330 |
Panoramic radiographic image |
383 |
355 |
$14K |
| D2140 |
|
295 |
225 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
150 |
$8K |
| D1351 |
Sealant - per tooth |
1,279 |
332 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
472 |
464 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
146 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,030 |
961 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,852 |
1,751 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
387 |
272 |
$393.81 |
| D0272 |
Bitewings - two radiographic images |
636 |
593 |
$287.43 |
| D1208 |
Topical application of fluoride, excluding varnish |
6,380 |
6,061 |
$222.07 |
| D1999 |
|
242 |
170 |
$209.58 |
| D0274 |
Bitewings - four radiographic images |
461 |
433 |
$208.24 |
| D1330 |
|
5,071 |
4,798 |
$157.96 |
| D0145 |
Oral evaluation for a patient under three years of age |
282 |
277 |
$150.92 |
| D0240 |
|
126 |
117 |
$112.95 |
| D0602 |
|
5,582 |
5,413 |
$62.71 |
| D9996 |
|
346 |
342 |
$0.00 |
| D9986 |
|
287 |
278 |
$0.00 |