| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,164 |
6,160 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
3,314 |
3,311 |
$222K |
| D1310 |
|
3,219 |
3,214 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,024 |
6,020 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,544 |
1,541 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,878 |
4,049 |
$75K |
| D1351 |
Sealant - per tooth |
1,609 |
459 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
804 |
446 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
327 |
182 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
543 |
543 |
$37K |
| D9993 |
|
547 |
546 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
854 |
835 |
$34K |
| D0603 |
|
2,147 |
2,145 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
273 |
156 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,975 |
1,975 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
204 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
215 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
120 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
1,052 |
$12K |
| D0350 |
|
943 |
547 |
$10K |
| D0274 |
Bitewings - four radiographic images |
444 |
444 |
$9K |
| D0602 |
|
591 |
591 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D1320 |
|
13 |
13 |
$80.00 |