| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,336 |
14,232 |
$715K |
| D1310 |
|
9,818 |
9,732 |
$441K |
| D0120 |
Periodic oral evaluation - established patient |
6,659 |
6,612 |
$434K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,527 |
13,429 |
$318K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,183 |
4,152 |
$278K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,636 |
1,503 |
$253K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,151 |
1,322 |
$250K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,476 |
3,448 |
$233K |
| D1351 |
Sealant - per tooth |
5,371 |
1,615 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,523 |
9,546 |
$179K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,854 |
3,735 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,059 |
1,353 |
$135K |
| D0603 |
|
7,990 |
7,930 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
7,350 |
7,119 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,211 |
808 |
$67K |
| D0350 |
|
9,530 |
3,120 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
423 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,528 |
2,510 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
344 |
$27K |
| D9430 |
|
739 |
730 |
$23K |
| D0602 |
|
1,545 |
1,540 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
329 |
214 |
$21K |
| D2330 |
|
219 |
128 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
216 |
$10K |
| D0274 |
Bitewings - four radiographic images |
505 |
502 |
$9K |
| D1510 |
|
42 |
40 |
$7K |
| D2140 |
|
63 |
44 |
$3K |
| D2335 |
|
27 |
15 |
$3K |
| D2332 |
|
43 |
26 |
$3K |
| D2160 |
|
17 |
16 |
$1K |
| D9993 |
|
61 |
61 |
$0.00 |