| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
648 |
590 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
179 |
102 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
725 |
657 |
$16K |
| D1206 |
Topical application of fluoride varnish |
831 |
753 |
$15K |
| D9248 |
|
158 |
125 |
$10K |
| D0272 |
Bitewings - two radiographic images |
555 |
505 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
79 |
47 |
$5K |
| D1110 |
Prophylaxis - adult |
113 |
101 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
140 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
119 |
$3K |
| D2140 |
|
62 |
49 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
38 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
56 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
31 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
61 |
$760.80 |
| D9110 |
|
15 |
12 |
$585.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$317.20 |