| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,628 |
2,365 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,748 |
4,238 |
$121K |
| D0272 |
Bitewings - two radiographic images |
3,974 |
3,546 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,225 |
3,765 |
$81K |
| D1120 |
Prophylaxis - child |
2,052 |
1,811 |
$70K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
483 |
193 |
$66K |
| D2140 |
|
906 |
431 |
$58K |
| D0240 |
|
2,307 |
1,066 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,490 |
1,223 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
322 |
174 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
410 |
189 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
314 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
633 |
535 |
$11K |
| D1351 |
Sealant - per tooth |
381 |
81 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
96 |
53 |
$8K |
| D0601 |
|
1,156 |
1,071 |
$6K |
| D0602 |
|
326 |
317 |
$2K |
| D1999 |
|
14 |
14 |
$0.00 |