| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,598 |
7,497 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
7,533 |
7,428 |
$192K |
| D0330 |
Panoramic radiographic image |
3,174 |
3,117 |
$189K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,914 |
1,385 |
$164K |
| D0274 |
Bitewings - four radiographic images |
4,289 |
4,227 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,608 |
3,561 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,881 |
6,801 |
$136K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
730 |
231 |
$128K |
| D1110 |
Prophylaxis - adult |
3,403 |
3,355 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,573 |
770 |
$121K |
| D1351 |
Sealant - per tooth |
2,491 |
1,171 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
1,961 |
1,882 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,556 |
2,531 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,136 |
2,917 |
$45K |
| D2140 |
|
621 |
483 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
69 |
$14K |
| D9630 |
|
392 |
377 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
435 |
387 |
$10K |
| D9420 |
|
34 |
26 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
26 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
554 |
344 |
$7K |
| D2160 |
|
53 |
42 |
$5K |
| D7111 |
|
40 |
27 |
$2K |
| D0240 |
|
36 |
26 |
$859.12 |