| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,681 |
3,570 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,548 |
4,427 |
$123K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
737 |
300 |
$97K |
| D2140 |
|
1,283 |
822 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,553 |
4,425 |
$86K |
| D1110 |
Prophylaxis - adult |
1,666 |
1,632 |
$81K |
| D1351 |
Sealant - per tooth |
2,389 |
923 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,566 |
2,489 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
594 |
378 |
$49K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
229 |
123 |
$18K |
| D1206 |
Topical application of fluoride varnish |
411 |
407 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
157 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
681 |
529 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
97 |
$5K |
| D9920 |
|
71 |
65 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
26 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$315.00 |