| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,950 |
4,882 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,318 |
5,247 |
$103K |
| D1110 |
Prophylaxis - adult |
2,190 |
2,178 |
$103K |
| D1120 |
Prophylaxis - child |
2,977 |
2,924 |
$101K |
| D0272 |
Bitewings - two radiographic images |
4,018 |
3,985 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
4,986 |
4,919 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,771 |
4,709 |
$66K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
484 |
232 |
$64K |
| D9248 |
|
517 |
498 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,097 |
1,062 |
$28K |
| D2140 |
|
289 |
224 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
200 |
113 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
408 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
135 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
143 |
108 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
96 |
$3K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$259.40 |
| D0603 |
|
34 |
33 |
$170.00 |
| D0601 |
|
29 |
29 |
$140.00 |
| D0602 |
|
13 |
13 |
$60.00 |