| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
763 |
762 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
455 |
445 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
220 |
178 |
$30K |
| D1206 |
Topical application of fluoride varnish |
738 |
737 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
149 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
444 |
441 |
$13K |
| D1351 |
Sealant - per tooth |
253 |
127 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
418 |
$11K |
| D2140 |
|
158 |
131 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
76 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
68 |
$5K |
| D0272 |
Bitewings - two radiographic images |
391 |
390 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
112 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
448 |
444 |
$3K |
| D0274 |
Bitewings - four radiographic images |
146 |
146 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
318 |
317 |
$2K |
| D0330 |
Panoramic radiographic image |
121 |
121 |
$2K |