| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,465 |
19,361 |
$967K |
| D0120 |
Periodic oral evaluation - established patient |
11,781 |
11,719 |
$838K |
| D1310 |
|
9,578 |
9,514 |
$426K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,076 |
18,975 |
$380K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,547 |
5,515 |
$373K |
| D1351 |
Sealant - per tooth |
9,156 |
2,632 |
$332K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,490 |
1,750 |
$292K |
| D0350 |
|
30,508 |
10,651 |
$255K |
| D0230 |
Intraoral - periapical each additional radiographic image |
60,341 |
15,239 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,244 |
2,585 |
$214K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,919 |
1,525 |
$186K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,327 |
2,317 |
$163K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,181 |
3,002 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,228 |
1,639 |
$126K |
| D0274 |
Bitewings - four radiographic images |
5,403 |
5,381 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,050 |
1,710 |
$109K |
| D0603 |
|
6,325 |
6,280 |
$91K |
| D0272 |
Bitewings - two radiographic images |
6,332 |
6,296 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,598 |
3,548 |
$43K |
| D9993 |
|
523 |
523 |
$33K |
| D0601 |
|
2,203 |
2,186 |
$32K |
| D9430 |
|
958 |
942 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
205 |
195 |
$16K |
| D0602 |
|
367 |
367 |
$5K |
| D0330 |
Panoramic radiographic image |
179 |
177 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
87 |
$4K |
| D0270 |
|
93 |
93 |
$460.00 |