| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,524 |
1,481 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,335 |
2,089 |
$67K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
121 |
108 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,093 |
2,051 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,313 |
1,999 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,244 |
2,194 |
$33K |
| D1120 |
Prophylaxis - child |
712 |
712 |
$21K |
| D0274 |
Bitewings - four radiographic images |
653 |
637 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
165 |
51 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
41 |
$8K |
| D2161 |
|
72 |
64 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
779 |
499 |
$6K |
| D2931 |
|
27 |
25 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
132 |
$4K |
| D3221 |
|
30 |
26 |
$4K |
| D1206 |
Topical application of fluoride varnish |
185 |
185 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
37 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$219.60 |