| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,610 |
750 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,795 |
2,167 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,639 |
2,584 |
$61K |
| D1120 |
Prophylaxis - child |
1,950 |
1,904 |
$60K |
| D1351 |
Sealant - per tooth |
2,068 |
519 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,852 |
2,794 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
644 |
349 |
$49K |
| D1110 |
Prophylaxis - adult |
920 |
895 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,848 |
1,794 |
$31K |
| D1353 |
|
1,056 |
232 |
$28K |
| D2332 |
|
325 |
156 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
270 |
156 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
255 |
196 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
784 |
770 |
$16K |
| D2140 |
|
243 |
185 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
162 |
$13K |
| D2330 |
|
165 |
108 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
77 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
119 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
127 |
110 |
$1K |
| D2331 |
|
16 |
12 |
$1K |