| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,933 |
6,900 |
$335K |
| D1120 |
Prophylaxis - child |
9,161 |
9,110 |
$311K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,769 |
1,241 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,747 |
8,695 |
$170K |
| D9993 |
|
1,610 |
1,609 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,106 |
2,093 |
$97K |
| D1310 |
|
2,139 |
2,123 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,152 |
9,101 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,342 |
688 |
$68K |
| D0272 |
Bitewings - two radiographic images |
5,982 |
5,945 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,189 |
755 |
$65K |
| D1351 |
Sealant - per tooth |
4,050 |
955 |
$64K |
| D0145 |
Oral evaluation for a patient under three years of age |
857 |
853 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
932 |
895 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,395 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
258 |
125 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
219 |
113 |
$23K |
| D0603 |
|
1,570 |
1,556 |
$23K |
| D9430 |
|
444 |
441 |
$14K |
| D0350 |
|
1,913 |
973 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
994 |
959 |
$11K |
| D0601 |
|
223 |
223 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |
| D0602 |
|
111 |
111 |
$2K |