| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,182 |
1,231 |
$126K |
| D1120 |
Prophylaxis - child |
4,998 |
4,237 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,709 |
4,818 |
$79K |
| D1999 |
|
4,889 |
4,235 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,895 |
3,377 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,238 |
215 |
$47K |
| D9420 |
|
302 |
194 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,049 |
1,707 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,056 |
187 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,092 |
1,831 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
842 |
266 |
$20K |
| D1110 |
Prophylaxis - adult |
323 |
262 |
$11K |
| D2140 |
|
189 |
53 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
443 |
$3K |
| D1206 |
Topical application of fluoride varnish |
41 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
47 |
$845.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
39 |
$315.38 |