| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,463 |
21,366 |
$968K |
| D0120 |
Periodic oral evaluation - established patient |
14,358 |
14,276 |
$927K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,823 |
1,935 |
$571K |
| D1310 |
|
10,826 |
10,776 |
$494K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,015 |
1,876 |
$489K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,405 |
2,985 |
$424K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,725 |
4,714 |
$315K |
| D1206 |
Topical application of fluoride varnish |
17,056 |
16,970 |
$302K |
| D1351 |
Sealant - per tooth |
8,251 |
2,513 |
$276K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,755 |
6,493 |
$270K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,594 |
2,597 |
$256K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,755 |
18,407 |
$228K |
| D9993 |
|
2,504 |
2,501 |
$161K |
| D0272 |
Bitewings - two radiographic images |
13,594 |
13,524 |
$159K |
| D0603 |
|
10,148 |
10,099 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,083 |
1,224 |
$111K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,462 |
1,462 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,413 |
3,406 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,508 |
5,382 |
$65K |
| D0350 |
|
4,967 |
2,763 |
$51K |
| D9430 |
|
1,536 |
1,482 |
$48K |
| D1510 |
|
156 |
129 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
17 |
$2K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D1354 |
|
78 |
38 |
$792.00 |
| D0270 |
|
24 |
24 |
$110.00 |