| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,596 |
9,543 |
$481K |
| D0120 |
Periodic oral evaluation - established patient |
4,786 |
4,777 |
$317K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,797 |
3,757 |
$249K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,923 |
564 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,544 |
1,691 |
$228K |
| D1310 |
|
5,313 |
5,286 |
$211K |
| D1206 |
Topical application of fluoride varnish |
9,020 |
8,978 |
$194K |
| D1351 |
Sealant - per tooth |
4,293 |
1,443 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,681 |
6,644 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,658 |
1,236 |
$140K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,950 |
952 |
$108K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,041 |
447 |
$102K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,300 |
1,293 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,171 |
1,929 |
$86K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
455 |
206 |
$68K |
| D0603 |
|
3,681 |
3,663 |
$54K |
| D0350 |
|
4,197 |
1,923 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
323 |
$37K |
| D0272 |
Bitewings - two radiographic images |
3,108 |
3,088 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,956 |
2,870 |
$34K |
| D9222 |
|
200 |
200 |
$24K |
| D9610 |
|
774 |
216 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
354 |
354 |
$17K |
| D0601 |
|
1,133 |
1,126 |
$17K |
| D0274 |
Bitewings - four radiographic images |
665 |
665 |
$14K |
| D9430 |
|
411 |
400 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
415 |
404 |
$9K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$5K |
| D3230 |
|
41 |
13 |
$4K |
| D0602 |
|
176 |
176 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
12 |
$2K |