| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,155 |
1,983 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,269 |
2,078 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,482 |
1,345 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
245 |
53 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
142 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
476 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
151 |
39 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
73 |
$9K |
| D0272 |
Bitewings - two radiographic images |
744 |
707 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
90 |
$2K |
| D1351 |
Sealant - per tooth |
86 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
302 |
287 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
98 |
$530.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
15 |
$390.00 |