| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,018 |
6,982 |
$323K |
| D0120 |
Periodic oral evaluation - established patient |
4,406 |
4,381 |
$304K |
| D1310 |
|
3,673 |
3,660 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,164 |
2,159 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,697 |
5,671 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,387 |
714 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,970 |
7,152 |
$77K |
| D0272 |
Bitewings - two radiographic images |
5,145 |
5,116 |
$59K |
| D9993 |
|
978 |
977 |
$51K |
| D0603 |
|
3,580 |
3,568 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
416 |
146 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
794 |
741 |
$32K |
| D1351 |
Sealant - per tooth |
711 |
240 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
410 |
218 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
633 |
629 |
$22K |
| D9430 |
|
669 |
662 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
281 |
281 |
$20K |
| D0274 |
Bitewings - four radiographic images |
680 |
678 |
$14K |
| D0330 |
Panoramic radiographic image |
493 |
492 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
139 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
934 |
921 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
80 |
37 |
$8K |
| D1206 |
Topical application of fluoride varnish |
510 |
510 |
$7K |
| D0350 |
|
481 |
276 |
$4K |