| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,266 |
2,266 |
$58K |
| D1120 |
Prophylaxis - child |
1,575 |
1,575 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,166 |
2,166 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,512 |
1,511 |
$34K |
| D1110 |
Prophylaxis - adult |
575 |
575 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
233 |
233 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
246 |
180 |
$19K |
| D1351 |
Sealant - per tooth |
465 |
153 |
$13K |
| D2140 |
|
198 |
153 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
79 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
469 |
454 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
89 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
121 |
$4K |
| D0240 |
|
158 |
157 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
138 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$923.13 |