| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,498 |
12,495 |
$499K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,553 |
1,691 |
$486K |
| D0120 |
Periodic oral evaluation - established patient |
11,199 |
11,196 |
$423K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,622 |
3,254 |
$208K |
| D1206 |
Topical application of fluoride varnish |
12,192 |
12,189 |
$175K |
| D0272 |
Bitewings - two radiographic images |
5,835 |
5,834 |
$158K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,128 |
1,164 |
$150K |
| D1351 |
Sealant - per tooth |
2,861 |
1,145 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,499 |
873 |
$102K |
| D0330 |
Panoramic radiographic image |
1,029 |
1,029 |
$90K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
520 |
316 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
1,881 |
1,865 |
$34K |
| D2140 |
|
315 |
213 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
866 |
862 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
292 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
230 |
230 |
$9K |
| D0274 |
Bitewings - four radiographic images |
115 |
115 |
$6K |