| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,040 |
1,999 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,027 |
1,985 |
$40K |
| D1120 |
Prophylaxis - child |
1,104 |
1,080 |
$39K |
| D1110 |
Prophylaxis - adult |
814 |
797 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,543 |
1,507 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
267 |
101 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
196 |
83 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
154 |
118 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
330 |
294 |
$9K |
| D1351 |
Sealant - per tooth |
223 |
55 |
$6K |
| D2140 |
|
79 |
60 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
47 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
137 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
70 |
$2K |