| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,247 |
10,645 |
$434K |
| D0120 |
Periodic oral evaluation - established patient |
10,493 |
9,949 |
$278K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,461 |
9,890 |
$255K |
| D1351 |
Sealant - per tooth |
2,771 |
1,898 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
970 |
422 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,855 |
1,008 |
$102K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,384 |
2,141 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
611 |
433 |
$34K |
| D0272 |
Bitewings - two radiographic images |
3,734 |
3,506 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,323 |
1,274 |
$21K |
| D1206 |
Topical application of fluoride varnish |
623 |
623 |
$17K |
| D0330 |
Panoramic radiographic image |
905 |
862 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
705 |
641 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
207 |
114 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
603 |
540 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
723 |
668 |
$9K |
| D2140 |
|
217 |
174 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
52 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
744 |
699 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
14 |
$72.20 |
| D0240 |
|
14 |
14 |
$0.00 |