| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
962 |
233 |
$92K |
| D1120 |
Prophylaxis - child |
1,641 |
1,612 |
$91K |
| D1206 |
Topical application of fluoride varnish |
1,635 |
1,604 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
983 |
625 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,565 |
1,473 |
$49K |
| D1351 |
Sealant - per tooth |
1,932 |
571 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,203 |
1,667 |
$38K |
| D3110 |
|
1,948 |
824 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,529 |
1,492 |
$34K |
| D2140 |
|
530 |
366 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
295 |
231 |
$26K |
| D2160 |
|
274 |
197 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
400 |
243 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
346 |
224 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,756 |
1,758 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
914 |
$16K |
| D9215 |
|
2,646 |
1,286 |
$15K |
| D0330 |
Panoramic radiographic image |
363 |
358 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
160 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
135 |
132 |
$4K |