| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,932 |
8,333 |
$417K |
| D0240 |
|
15,437 |
8,263 |
$374K |
| D0120 |
Periodic oral evaluation - established patient |
14,260 |
13,045 |
$371K |
| D0272 |
Bitewings - two radiographic images |
13,853 |
12,789 |
$318K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,862 |
14,647 |
$311K |
| D1120 |
Prophylaxis - child |
6,949 |
6,332 |
$239K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,376 |
502 |
$188K |
| D2140 |
|
2,550 |
1,572 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
1,806 |
1,702 |
$148K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,528 |
968 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,767 |
4,120 |
$119K |
| D9248 |
|
1,039 |
897 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,094 |
635 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,468 |
1,466 |
$49K |
| D0330 |
Panoramic radiographic image |
658 |
650 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
345 |
$13K |
| D1510 |
|
67 |
55 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
636 |
551 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
16 |
$3K |