| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,687 |
6,673 |
$239K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,621 |
808 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
7,322 |
7,303 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,793 |
7,775 |
$157K |
| D2140 |
|
1,779 |
1,071 |
$123K |
| D1351 |
Sealant - per tooth |
3,589 |
1,383 |
$109K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,039 |
566 |
$98K |
| D1110 |
Prophylaxis - adult |
1,905 |
1,899 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,112 |
686 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,988 |
3,969 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
423 |
259 |
$33K |
| D9920 |
|
463 |
432 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
451 |
451 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,250 |
1,219 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
226 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
363 |
$5K |
| D1206 |
Topical application of fluoride varnish |
129 |
128 |
$4K |
| D7111 |
|
62 |
43 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
180 |
114 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |