| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,403 |
14,378 |
$453K |
| D0120 |
Periodic oral evaluation - established patient |
14,286 |
14,266 |
$307K |
| D1351 |
Sealant - per tooth |
6,511 |
2,224 |
$261K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,413 |
2,983 |
$254K |
| D0274 |
Bitewings - four radiographic images |
10,103 |
10,095 |
$209K |
| D1110 |
Prophylaxis - adult |
4,235 |
4,231 |
$171K |
| D9990 |
|
8,153 |
7,462 |
$168K |
| D1206 |
Topical application of fluoride varnish |
6,998 |
6,984 |
$167K |
| D0220 |
Intraoral - periapical first radiographic image |
15,230 |
15,190 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,878 |
11,859 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,808 |
1,571 |
$113K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,246 |
857 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,669 |
12,660 |
$69K |
| D9243 |
|
269 |
267 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,665 |
1,327 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,804 |
2,796 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,043 |
4,041 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
619 |
505 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,081 |
1,081 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,814 |
1,792 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
341 |
257 |
$20K |
| D0330 |
Panoramic radiographic image |
740 |
738 |
$16K |
| D1354 |
|
957 |
232 |
$15K |
| D9239 |
|
252 |
252 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
397 |
365 |
$11K |
| D9310 |
|
175 |
175 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
650 |
646 |
$5K |
| D9610 |
|
266 |
251 |
$3K |
| D2332 |
|
16 |
14 |
$2K |
| D2335 |
|
15 |
12 |
$1K |