| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,486 |
7,425 |
$375K |
| D0120 |
Periodic oral evaluation - established patient |
3,443 |
3,424 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,987 |
2,943 |
$196K |
| D1310 |
|
4,110 |
4,082 |
$185K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,413 |
7,351 |
$159K |
| D1351 |
Sealant - per tooth |
3,424 |
978 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,925 |
1,298 |
$125K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,597 |
2,158 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,031 |
5,501 |
$102K |
| D0350 |
|
12,379 |
4,971 |
$85K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,206 |
1,199 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,153 |
772 |
$64K |
| D0603 |
|
3,792 |
3,771 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,061 |
819 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,943 |
1,918 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,977 |
1,964 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,528 |
1,503 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
154 |
78 |
$18K |
| D0330 |
Panoramic radiographic image |
563 |
558 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
76 |
62 |
$7K |
| D9430 |
|
160 |
160 |
$5K |
| D9993 |
|
51 |
51 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |
| D2330 |
|
23 |
16 |
$2K |
| D0602 |
|
85 |
85 |
$1K |
| D0601 |
|
19 |
19 |
$285.00 |
| D0270 |
|
45 |
44 |
$223.75 |