| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,519 |
1,413 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
634 |
372 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,315 |
1,237 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,007 |
950 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
878 |
744 |
$22K |
| D2140 |
|
565 |
422 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
619 |
$12K |
| D1351 |
Sealant - per tooth |
267 |
130 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
117 |
$8K |
| D0272 |
Bitewings - two radiographic images |
774 |
718 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
92 |
70 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
845 |
772 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
74 |
$4K |
| D0274 |
Bitewings - four radiographic images |
263 |
250 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
195 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
702 |
608 |
$3K |
| D0330 |
Panoramic radiographic image |
100 |
86 |
$1K |