| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,085 |
17,986 |
$880K |
| D0120 |
Periodic oral evaluation - established patient |
10,720 |
10,652 |
$753K |
| D1310 |
|
10,409 |
10,351 |
$474K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,042 |
3,260 |
$403K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,376 |
5,356 |
$369K |
| D1206 |
Topical application of fluoride varnish |
17,398 |
17,299 |
$359K |
| D1351 |
Sealant - per tooth |
10,296 |
3,165 |
$353K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,808 |
1,739 |
$333K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,185 |
5,972 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,810 |
2,177 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,948 |
13,151 |
$193K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,711 |
2,700 |
$186K |
| D2330 |
|
1,674 |
982 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,163 |
1,528 |
$123K |
| D0603 |
|
8,244 |
8,201 |
$122K |
| D9993 |
|
1,668 |
1,666 |
$107K |
| D0350 |
|
8,174 |
3,915 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,393 |
6,305 |
$76K |
| D1510 |
|
312 |
282 |
$63K |
| D0272 |
Bitewings - two radiographic images |
5,096 |
5,072 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,143 |
1,137 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,282 |
2,267 |
$48K |
| D9430 |
|
1,127 |
1,096 |
$36K |
| D0602 |
|
1,888 |
1,874 |
$28K |
| D2331 |
|
201 |
136 |
$16K |
| D0330 |
Panoramic radiographic image |
411 |
409 |
$11K |
| D1354 |
|
555 |
290 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
76 |
$7K |
| D7111 |
|
53 |
32 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$1K |
| D0601 |
|
88 |
88 |
$1K |