| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,192 |
4,130 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
3,255 |
3,196 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,682 |
2,641 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
292 |
113 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
442 |
440 |
$27K |
| D1206 |
Topical application of fluoride varnish |
694 |
679 |
$17K |
| D9248 |
|
118 |
110 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
173 |
169 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
24 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
114 |
112 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
78 |
$1K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$892.41 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$495.00 |