| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,241 |
1,139 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
6,899 |
6,809 |
$141K |
| D1110 |
Prophylaxis - adult |
2,895 |
2,843 |
$126K |
| D1120 |
Prophylaxis - child |
4,239 |
4,193 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,106 |
6,035 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,556 |
2,520 |
$75K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
446 |
195 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,943 |
1,834 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,681 |
2,605 |
$40K |
| D0330 |
Panoramic radiographic image |
742 |
732 |
$35K |
| D2140 |
|
563 |
338 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,116 |
1,102 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
69 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
143 |
89 |
$17K |
| D0272 |
Bitewings - two radiographic images |
944 |
930 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
400 |
398 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,500 |
1,085 |
$11K |
| D2332 |
|
82 |
39 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
25 |
$4K |
| D3120 |
|
121 |
66 |
$4K |