| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,428 |
5,744 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,334 |
7,458 |
$117K |
| D1999 |
|
7,625 |
6,894 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,677 |
1,184 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,699 |
516 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
6,817 |
6,097 |
$96K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,683 |
511 |
$80K |
| D1110 |
Prophylaxis - adult |
2,122 |
1,892 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,357 |
3,029 |
$48K |
| D0330 |
Panoramic radiographic image |
1,330 |
1,152 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,702 |
1,520 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,448 |
1,847 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
482 |
198 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,839 |
1,715 |
$13K |
| D2160 |
|
294 |
130 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
148 |
$7K |