| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
23,989 |
23,876 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
15,696 |
15,616 |
$1.03M |
| D1310 |
|
11,196 |
11,123 |
$497K |
| D1351 |
Sealant - per tooth |
15,457 |
5,004 |
$491K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,966 |
3,327 |
$466K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,784 |
5,768 |
$389K |
| D0230 |
Intraoral - periapical each additional radiographic image |
86,748 |
18,361 |
$383K |
| D1206 |
Topical application of fluoride varnish |
23,057 |
22,951 |
$377K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,815 |
2,714 |
$275K |
| D2140 |
|
4,722 |
2,545 |
$257K |
| D9993 |
|
4,138 |
4,138 |
$244K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,459 |
5,297 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
14,046 |
13,900 |
$168K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,405 |
698 |
$167K |
| D0603 |
|
10,725 |
10,654 |
$156K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,068 |
2,059 |
$137K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,116 |
540 |
$110K |
| D0350 |
|
9,106 |
4,402 |
$100K |
| D0272 |
Bitewings - two radiographic images |
5,817 |
5,802 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
657 |
656 |
$31K |
| D2330 |
|
311 |
171 |
$23K |
| D2160 |
|
263 |
161 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
739 |
735 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
111 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
72 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
13 |
$8K |
| D9430 |
|
119 |
115 |
$4K |
| D1510 |
|
19 |
16 |
$2K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$1K |
| D0601 |
|
75 |
75 |
$1K |
| D0602 |
|
34 |
34 |
$495.00 |