| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,014 |
23,908 |
$1.23M |
| D0120 |
Periodic oral evaluation - established patient |
13,358 |
13,297 |
$976K |
| D1310 |
|
12,441 |
12,377 |
$570K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,475 |
7,451 |
$516K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,080 |
3,490 |
$475K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,997 |
1,667 |
$474K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,570 |
21,376 |
$431K |
| D1351 |
Sealant - per tooth |
9,544 |
3,064 |
$363K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,017 |
8,834 |
$360K |
| D1206 |
Topical application of fluoride varnish |
10,339 |
10,286 |
$318K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,163 |
3,144 |
$228K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,642 |
2,313 |
$208K |
| D2140 |
|
3,439 |
2,017 |
$187K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,906 |
951 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,345 |
13,292 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
15,051 |
14,953 |
$180K |
| D0603 |
|
8,330 |
8,291 |
$124K |
| D0350 |
|
5,399 |
4,931 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,967 |
3,950 |
$86K |
| D2330 |
|
1,003 |
572 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,296 |
1,295 |
$62K |
| D0602 |
|
3,403 |
3,386 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,297 |
3,270 |
$39K |
| D9993 |
|
577 |
577 |
$37K |
| D2160 |
|
432 |
295 |
$34K |
| D1320 |
|
2,470 |
2,470 |
$25K |
| D1510 |
|
93 |
75 |
$19K |
| D9430 |
|
445 |
431 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
100 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
77 |
$6K |
| D2331 |
|
22 |
18 |
$2K |
| D0601 |
|
14 |
14 |
$210.00 |
| D0270 |
|
12 |
12 |
$60.00 |