| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,312 |
5,281 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
3,369 |
3,354 |
$129K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,930 |
894 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,790 |
1,775 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
750 |
458 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,310 |
5,278 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,473 |
1,380 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,711 |
5,108 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
970 |
524 |
$53K |
| D9993 |
|
818 |
818 |
$52K |
| D1351 |
Sealant - per tooth |
2,067 |
529 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,851 |
3,829 |
$43K |
| D1310 |
|
818 |
818 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
530 |
529 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
158 |
$18K |
| D9430 |
|
561 |
534 |
$17K |
| D0274 |
Bitewings - four radiographic images |
637 |
630 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
66 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
678 |
668 |
$8K |
| D0602 |
|
464 |
464 |
$7K |
| D0350 |
|
516 |
325 |
$5K |
| D2330 |
|
62 |
31 |
$4K |
| D0603 |
|
173 |
173 |
$3K |
| D2160 |
|
28 |
25 |
$2K |
| D2140 |
|
36 |
27 |
$2K |
| D0601 |
|
111 |
111 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$873.60 |
| D1999 |
|
14 |
14 |
$0.00 |