| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,587 |
6,490 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
8,534 |
8,416 |
$160K |
| D1999 |
|
5,830 |
5,518 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,673 |
6,555 |
$98K |
| D1110 |
Prophylaxis - adult |
2,696 |
2,641 |
$96K |
| D0330 |
Panoramic radiographic image |
1,975 |
1,928 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,042 |
3,003 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,055 |
725 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,290 |
3,247 |
$58K |
| D2140 |
|
864 |
639 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,856 |
1,766 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,306 |
1,277 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
904 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
121 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
257 |
$8K |
| D1351 |
Sealant - per tooth |
238 |
50 |
$6K |
| D2330 |
|
17 |
12 |
$921.40 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$902.00 |