| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,689 |
4,391 |
$219K |
| D1351 |
Sealant - per tooth |
4,027 |
825 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,990 |
2,801 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,376 |
785 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,651 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,008 |
2,806 |
$69K |
| D9248 |
|
344 |
291 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
534 |
326 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
737 |
674 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,574 |
1,358 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,996 |
1,870 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
143 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,670 |
1,573 |
$23K |
| D0240 |
|
2,313 |
746 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
225 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,654 |
1,528 |
$13K |
| D0603 |
|
1,508 |
1,414 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
142 |
92 |
$9K |
| D0330 |
Panoramic radiographic image |
235 |
213 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,226 |
1,124 |
$8K |
| D0602 |
|
1,155 |
1,067 |
$7K |
| D0601 |
|
1,007 |
932 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$567.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
14 |
$178.48 |