| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,450 |
15,450 |
$446K |
| D0120 |
Periodic oral evaluation - established patient |
14,351 |
14,351 |
$400K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,113 |
5,586 |
$349K |
| D0272 |
Bitewings - two radiographic images |
13,545 |
13,544 |
$257K |
| D0220 |
Intraoral - periapical first radiographic image |
18,998 |
18,636 |
$225K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,425 |
1,461 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,418 |
16,357 |
$175K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,870 |
1,886 |
$150K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,917 |
11,917 |
$145K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,087 |
1,227 |
$141K |
| D1206 |
Topical application of fluoride varnish |
4,922 |
4,922 |
$129K |
| D1351 |
Sealant - per tooth |
3,512 |
1,382 |
$99K |
| D9110 |
|
1,341 |
1,265 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,221 |
2,127 |
$67K |
| D0330 |
Panoramic radiographic image |
1,070 |
1,070 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,023 |
700 |
$52K |
| D1110 |
Prophylaxis - adult |
1,131 |
1,131 |
$45K |
| D2140 |
|
612 |
446 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
143 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
539 |
$19K |
| D2332 |
|
140 |
82 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
366 |
366 |
$11K |
| D0274 |
Bitewings - four radiographic images |
156 |
156 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
27 |
$3K |
| D2160 |
|
35 |
27 |
$2K |
| D7111 |
|
20 |
13 |
$1K |