| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,496 |
2,496 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
2,362 |
2,362 |
$93K |
| D1206 |
Topical application of fluoride varnish |
2,512 |
2,512 |
$80K |
| D1351 |
Sealant - per tooth |
2,110 |
386 |
$75K |
| D0272 |
Bitewings - two radiographic images |
1,978 |
1,978 |
$36K |
| D0240 |
|
858 |
858 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
886 |
833 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,196 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
169 |
126 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
74 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,006 |
1,006 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
28 |
$5K |
| D0603 |
|
414 |
414 |
$4K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$4K |
| D0602 |
|
326 |
326 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$2K |
| D0601 |
|
116 |
116 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$580.00 |