| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,436 |
22,402 |
$1.10M |
| D0120 |
Periodic oral evaluation - established patient |
12,040 |
12,015 |
$806K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,256 |
8,248 |
$548K |
| D1310 |
|
12,195 |
12,167 |
$514K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,381 |
22,343 |
$465K |
| D1351 |
Sealant - per tooth |
11,393 |
3,332 |
$427K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,776 |
3,171 |
$317K |
| D0350 |
|
41,004 |
16,594 |
$316K |
| D0230 |
Intraoral - periapical each additional radiographic image |
78,357 |
19,507 |
$303K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,381 |
3,029 |
$246K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,177 |
3,173 |
$217K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,946 |
4,659 |
$197K |
| D0603 |
|
9,413 |
9,398 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,079 |
1,633 |
$112K |
| D0274 |
Bitewings - four radiographic images |
5,916 |
5,911 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,089 |
8,030 |
$96K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
709 |
412 |
$83K |
| D0272 |
Bitewings - two radiographic images |
5,852 |
5,840 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
800 |
625 |
$63K |
| D9430 |
|
1,624 |
1,581 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
796 |
796 |
$38K |
| D0330 |
Panoramic radiographic image |
1,217 |
1,207 |
$33K |
| D9993 |
|
518 |
518 |
$32K |
| D0602 |
|
1,726 |
1,725 |
$24K |
| D2940 |
|
344 |
160 |
$17K |
| D2330 |
|
222 |
141 |
$17K |
| D0601 |
|
858 |
856 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
67 |
48 |
$7K |
| D1354 |
|
367 |
90 |
$3K |
| D2331 |
|
35 |
26 |
$3K |