| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
19,374 |
19,287 |
$860K |
| D0120 |
Periodic oral evaluation - established patient |
13,307 |
13,242 |
$842K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,026 |
3,469 |
$538K |
| D1310 |
|
10,079 |
10,036 |
$454K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89,632 |
18,729 |
$369K |
| D1351 |
Sealant - per tooth |
11,068 |
3,307 |
$340K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,323 |
19,237 |
$339K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,225 |
4,215 |
$287K |
| D7111 |
|
4,964 |
2,648 |
$285K |
| D9993 |
|
3,440 |
3,440 |
$212K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,761 |
4,492 |
$190K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,738 |
675 |
$172K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,148 |
2,137 |
$144K |
| D0603 |
|
9,545 |
9,503 |
$140K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,130 |
507 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,398 |
1,322 |
$130K |
| D0272 |
Bitewings - two radiographic images |
10,210 |
10,170 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
10,094 |
9,981 |
$121K |
| D2330 |
|
598 |
313 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
527 |
247 |
$35K |
| D9430 |
|
1,044 |
1,011 |
$33K |
| D0350 |
|
2,731 |
1,549 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
149 |
$17K |
| D2140 |
|
243 |
148 |
$13K |
| D2160 |
|
122 |
69 |
$10K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$476.00 |
| D0601 |
|
25 |
25 |
$375.00 |