| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,801 |
7,643 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
10,853 |
10,639 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,602 |
12,284 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,670 |
822 |
$143K |
| D0330 |
Panoramic radiographic image |
2,692 |
2,616 |
$114K |
| D1110 |
Prophylaxis - adult |
3,381 |
3,305 |
$110K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,984 |
1,216 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,354 |
4,258 |
$70K |
| D2140 |
|
1,401 |
943 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,126 |
2,061 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
519 |
354 |
$25K |
| D2160 |
|
243 |
168 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
826 |
784 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
25 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,155 |
1,127 |
$12K |
| D1351 |
Sealant - per tooth |
391 |
109 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
310 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
96 |
68 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
244 |
233 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
65 |
$1K |