| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,666 |
4,396 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,956 |
6,539 |
$111K |
| D1351 |
Sealant - per tooth |
5,231 |
930 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
6,436 |
6,083 |
$106K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,028 |
1,430 |
$102K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,528 |
3,631 |
$98K |
| D1110 |
Prophylaxis - adult |
2,414 |
2,287 |
$84K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
714 |
510 |
$72K |
| D2140 |
|
1,686 |
1,245 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,437 |
3,228 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,106 |
720 |
$58K |
| D0330 |
Panoramic radiographic image |
1,178 |
1,125 |
$55K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
582 |
419 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
861 |
782 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
784 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
885 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
363 |
240 |
$3K |
| D9920 |
|
15 |
12 |
$514.25 |
| D2330 |
|
22 |
13 |
$237.54 |