| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,669 |
1,666 |
$54K |
| D1120 |
Prophylaxis - child |
1,369 |
1,365 |
$52K |
| D9248 |
|
200 |
189 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,811 |
1,808 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
156 |
$26K |
| D1110 |
Prophylaxis - adult |
532 |
531 |
$24K |
| D0603 |
|
1,672 |
1,669 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
125 |
29 |
$15K |
| D0272 |
Bitewings - two radiographic images |
440 |
438 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
255 |
$10K |
| D9110 |
|
237 |
234 |
$9K |
| D1330 |
|
1,669 |
1,666 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
82 |
29 |
$8K |
| D1351 |
Sealant - per tooth |
159 |
50 |
$5K |
| D0274 |
Bitewings - four radiographic images |
98 |
98 |
$4K |
| D1206 |
Topical application of fluoride varnish |
112 |
112 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
139 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
24 |
$1K |
| D1999 |
|
40 |
40 |
$0.00 |