| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,178 |
1,177 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,380 |
1,376 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,687 |
1,682 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
498 |
479 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
190 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
263 |
173 |
$16K |
| D1330 |
|
1,456 |
1,451 |
$15K |
| D1310 |
|
1,458 |
1,453 |
$15K |
| D1110 |
Prophylaxis - adult |
330 |
328 |
$15K |
| D1354 |
|
279 |
220 |
$15K |
| D0272 |
Bitewings - two radiographic images |
407 |
406 |
$8K |
| D2140 |
|
143 |
107 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
301 |
297 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
646 |
625 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
51 |
25 |
$5K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$4K |
| D1351 |
Sealant - per tooth |
167 |
40 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
67 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
57 |
$2K |
| D0603 |
|
130 |
130 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$885.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$414.36 |
| D1320 |
|
14 |
14 |
$270.62 |