| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,811 |
2,261 |
$519K |
| D1120 |
Prophylaxis - child |
7,553 |
7,551 |
$321K |
| D1206 |
Topical application of fluoride varnish |
8,767 |
8,710 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
6,864 |
6,863 |
$234K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
606 |
171 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
1,444 |
1,441 |
$90K |
| D2140 |
|
975 |
716 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,730 |
2,728 |
$69K |
| D1110 |
Prophylaxis - adult |
1,145 |
1,145 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
3,287 |
3,249 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,814 |
1,807 |
$52K |
| D1351 |
Sealant - per tooth |
1,774 |
634 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,053 |
$43K |
| D0330 |
Panoramic radiographic image |
360 |
360 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
210 |
79 |
$27K |
| D1354 |
|
1,173 |
318 |
$26K |
| D9420 |
|
145 |
145 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
328 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
94 |
$8K |
| D1352 |
|
64 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$1K |
| D9920 |
|
14 |
14 |
$550.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,144 |
1,118 |
$0.00 |