| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,543 |
10,454 |
$552K |
| D0120 |
Periodic oral evaluation - established patient |
6,746 |
6,746 |
$472K |
| D1351 |
Sealant - per tooth |
6,578 |
1,949 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,484 |
3,401 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,773 |
9,610 |
$215K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,526 |
10,434 |
$188K |
| D1310 |
|
2,600 |
2,571 |
$118K |
| D0274 |
Bitewings - four radiographic images |
5,064 |
5,028 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
833 |
592 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
663 |
418 |
$45K |
| D7111 |
|
726 |
535 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,276 |
3,192 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
302 |
200 |
$36K |
| D0350 |
|
3,770 |
1,730 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
593 |
431 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
406 |
400 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,969 |
1,949 |
$24K |
| D9430 |
|
604 |
565 |
$19K |
| D0603 |
|
1,130 |
1,118 |
$17K |
| D0601 |
|
410 |
402 |
$6K |
| D0602 |
|
283 |
277 |
$4K |
| D1354 |
|
169 |
45 |
$2K |
| D2160 |
|
18 |
13 |
$1K |
| D2140 |
|
26 |
17 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$1K |