| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
33,141 |
33,109 |
$1.14M |
| D0120 |
Periodic oral evaluation - established patient |
41,069 |
41,027 |
$1.12M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,018 |
4,969 |
$884K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19,651 |
19,429 |
$711K |
| D2140 |
|
10,000 |
8,813 |
$684K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,945 |
30,921 |
$606K |
| D1110 |
Prophylaxis - adult |
12,423 |
12,403 |
$591K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,968 |
5,000 |
$509K |
| D0272 |
Bitewings - two radiographic images |
21,259 |
21,213 |
$440K |
| D1206 |
Topical application of fluoride varnish |
15,810 |
15,779 |
$379K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,180 |
2,156 |
$292K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,343 |
4,314 |
$202K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,490 |
4,483 |
$197K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,128 |
1,945 |
$191K |
| D0220 |
Intraoral - periapical first radiographic image |
11,780 |
11,540 |
$163K |
| D2934 |
|
304 |
123 |
$63K |
| D1351 |
Sealant - per tooth |
1,658 |
551 |
$50K |
| D9920 |
|
766 |
713 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
2,345 |
2,310 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,013 |
1,480 |
$19K |
| D2330 |
|
231 |
190 |
$18K |
| D9248 |
|
115 |
106 |
$14K |
| D2931 |
|
39 |
37 |
$6K |
| D9420 |
|
49 |
49 |
$5K |
| D7111 |
|
50 |
45 |
$3K |
| D2950 |
|
15 |
14 |
$2K |
| D2331 |
|
17 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$912.80 |