| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,219 |
1,204 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,131 |
930 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
788 |
780 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,349 |
1,336 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
372 |
238 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
193 |
100 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
211 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
210 |
152 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
152 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
548 |
542 |
$12K |
| D0272 |
Bitewings - two radiographic images |
540 |
529 |
$11K |
| D1351 |
Sealant - per tooth |
458 |
189 |
$11K |
| D2140 |
|
155 |
109 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
435 |
419 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
121 |
$4K |
| D2330 |
|
53 |
27 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
29 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
53 |
53 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
27 |
$404.29 |
| D1354 |
|
50 |
48 |
$0.00 |