| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,967 |
3,767 |
$156K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
978 |
672 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,225 |
2,016 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,641 |
3,467 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,880 |
2,763 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
724 |
584 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,199 |
1,096 |
$27K |
| D1351 |
Sealant - per tooth |
554 |
304 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,404 |
2,265 |
$22K |
| D2140 |
|
450 |
362 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,475 |
2,298 |
$15K |
| D0274 |
Bitewings - four radiographic images |
733 |
709 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,910 |
1,669 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
133 |
$9K |
| D0330 |
Panoramic radiographic image |
268 |
260 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
183 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
161 |
140 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$843.20 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
40 |
$648.00 |
| D1999 |
|
389 |
302 |
$0.00 |