| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,329 |
4,329 |
$219K |
| D1351 |
Sealant - per tooth |
4,657 |
1,241 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,279 |
2,279 |
$152K |
| D1310 |
|
2,257 |
2,257 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,424 |
1,424 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,194 |
4,194 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,703 |
1,619 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
997 |
478 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,041 |
2,838 |
$60K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
464 |
188 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
859 |
431 |
$49K |
| D0145 |
Oral evaluation for a patient under three years of age |
609 |
609 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
354 |
150 |
$34K |
| D0603 |
|
2,252 |
2,252 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
457 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,709 |
1,703 |
$21K |
| D2140 |
|
331 |
190 |
$18K |
| D0350 |
|
1,480 |
577 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,186 |
1,186 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
75 |
$11K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
52 |
$6K |
| D9430 |
|
110 |
104 |
$3K |
| D2160 |
|
30 |
20 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
59 |
59 |
$1K |