| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,243 |
318 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
895 |
868 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
268 |
146 |
$21K |
| D9248 |
|
173 |
169 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
133 |
65 |
$19K |
| D1120 |
Prophylaxis - child |
550 |
539 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
129 |
128 |
$18K |
| D1110 |
Prophylaxis - adult |
338 |
330 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
903 |
$13K |
| D0272 |
Bitewings - two radiographic images |
418 |
409 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
707 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
99 |
52 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
745 |
645 |
$8K |
| D0274 |
Bitewings - four radiographic images |
244 |
231 |
$8K |
| D2140 |
|
61 |
39 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
126 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
29 |
$3K |
| D0603 |
|
876 |
861 |
$0.00 |
| D0602 |
|
98 |
96 |
$0.00 |
| D0601 |
|
232 |
227 |
$0.00 |