| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,201 |
5,674 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
10,443 |
9,481 |
$259K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,794 |
1,525 |
$207K |
| D0272 |
Bitewings - two radiographic images |
8,997 |
8,177 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,832 |
8,940 |
$185K |
| D1120 |
Prophylaxis - child |
4,555 |
4,091 |
$151K |
| D2140 |
|
2,113 |
1,222 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,546 |
659 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,411 |
2,922 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,026 |
960 |
$78K |
| D2160 |
|
388 |
162 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,954 |
1,719 |
$31K |
| D1351 |
Sealant - per tooth |
1,134 |
337 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
945 |
782 |
$28K |
| D0330 |
Panoramic radiographic image |
380 |
321 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
27 |
12 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
14 |
$185.25 |