| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,445 |
3,427 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
2,291 |
2,281 |
$111K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,509 |
624 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
692 |
330 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,430 |
581 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,179 |
1,172 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,784 |
1,736 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,536 |
3,513 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,208 |
3,787 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,185 |
2,162 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
447 |
446 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,950 |
1,940 |
$23K |
| D3240 |
|
155 |
91 |
$15K |
| D1351 |
Sealant - per tooth |
560 |
171 |
$13K |
| D9430 |
|
352 |
343 |
$11K |
| D1999 |
|
12 |
12 |
$0.00 |