| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,384 |
10,179 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
13,087 |
12,817 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,216 |
14,907 |
$219K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,044 |
1,179 |
$172K |
| D0330 |
Panoramic radiographic image |
3,350 |
3,285 |
$152K |
| D1110 |
Prophylaxis - adult |
3,377 |
3,322 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,037 |
5,921 |
$102K |
| D2140 |
|
1,498 |
1,123 |
$70K |
| D1351 |
Sealant - per tooth |
2,185 |
563 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,097 |
2,059 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
818 |
620 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
599 |
445 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
973 |
949 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
241 |
172 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,294 |
1,273 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
331 |
327 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
395 |
387 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$7K |
| D2330 |
|
34 |
25 |
$2K |