| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,956 |
13,848 |
$707K |
| D0120 |
Periodic oral evaluation - established patient |
8,843 |
8,775 |
$592K |
| D1310 |
|
9,555 |
9,482 |
$438K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,117 |
1,751 |
$371K |
| D1206 |
Topical application of fluoride varnish |
13,701 |
13,595 |
$310K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,022 |
2,351 |
$268K |
| D1351 |
Sealant - per tooth |
6,927 |
2,732 |
$249K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,707 |
5,398 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,281 |
3,257 |
$225K |
| D2335 |
|
1,818 |
1,130 |
$215K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,267 |
2,247 |
$157K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,543 |
982 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,013 |
9,712 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,223 |
1,232 |
$126K |
| D0603 |
|
7,684 |
7,628 |
$115K |
| D1354 |
|
6,972 |
1,284 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,436 |
1,075 |
$78K |
| D2330 |
|
928 |
585 |
$72K |
| D0350 |
|
6,704 |
3,389 |
$69K |
| D0272 |
Bitewings - two radiographic images |
5,105 |
5,061 |
$61K |
| D9993 |
|
832 |
832 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,824 |
1,809 |
$39K |
| D0601 |
|
1,805 |
1,789 |
$27K |
| D9430 |
|
642 |
622 |
$21K |
| D9420 |
|
123 |
39 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
111 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
359 |
357 |
$4K |
| D2941 |
|
33 |
15 |
$1K |