| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,246 |
13,158 |
$548K |
| D0120 |
Periodic oral evaluation - established patient |
8,433 |
8,378 |
$500K |
| D1310 |
|
6,326 |
6,292 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,380 |
2,253 |
$228K |
| D1206 |
Topical application of fluoride varnish |
10,754 |
10,670 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,444 |
2,435 |
$157K |
| D9993 |
|
2,487 |
2,487 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,328 |
1,612 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,076 |
628 |
$128K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,870 |
2,623 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,986 |
9,684 |
$97K |
| D0272 |
Bitewings - two radiographic images |
8,047 |
7,989 |
$95K |
| D0603 |
|
6,335 |
6,301 |
$93K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
752 |
435 |
$75K |
| D9430 |
|
2,325 |
2,231 |
$73K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,126 |
1,124 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
691 |
545 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
860 |
709 |
$47K |
| D0350 |
|
3,071 |
2,087 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,431 |
1,429 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,965 |
1,906 |
$23K |
| D0274 |
Bitewings - four radiographic images |
563 |
554 |
$12K |
| D2330 |
|
115 |
83 |
$9K |
| D1351 |
Sealant - per tooth |
92 |
32 |
$3K |
| D1354 |
|
57 |
28 |
$792.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D1330 |
|
644 |
642 |
$0.00 |