| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,362 |
1,252 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,594 |
1,474 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
236 |
32 |
$28K |
| D1354 |
|
562 |
128 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
895 |
837 |
$22K |
| D0272 |
Bitewings - two radiographic images |
585 |
517 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
240 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
166 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
479 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
31 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
137 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
545 |
178 |
$5K |
| D1110 |
Prophylaxis - adult |
80 |
75 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
13 |
$3K |
| D9310 |
|
48 |
48 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
35 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D9420 |
|
40 |
33 |
$1K |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$610.50 |