| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,528 |
502 |
$77K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
743 |
196 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
885 |
355 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,286 |
$32K |
| D9420 |
|
375 |
361 |
$30K |
| D2140 |
|
594 |
298 |
$25K |
| D1120 |
Prophylaxis - child |
1,099 |
1,091 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,013 |
1,007 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
219 |
89 |
$14K |
| D0272 |
Bitewings - two radiographic images |
815 |
807 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
291 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
251 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
179 |
162 |
$4K |
| D9310 |
|
101 |
101 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
284 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
154 |
152 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$719.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
24 |
$232.96 |