| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,379 |
12,324 |
$618K |
| D0120 |
Periodic oral evaluation - established patient |
7,526 |
7,499 |
$519K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,596 |
1,836 |
$427K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,121 |
1,637 |
$306K |
| D1310 |
|
6,368 |
6,341 |
$292K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,302 |
4,277 |
$287K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67,668 |
13,590 |
$281K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,171 |
1,960 |
$278K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,168 |
12,113 |
$245K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,959 |
4,568 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,846 |
1,528 |
$187K |
| D1351 |
Sealant - per tooth |
4,837 |
2,000 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,770 |
1,688 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,634 |
1,774 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
9,042 |
8,277 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,448 |
1,444 |
$98K |
| D1510 |
|
447 |
399 |
$89K |
| D0603 |
|
5,171 |
5,150 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,497 |
3,479 |
$74K |
| D2330 |
|
960 |
587 |
$74K |
| D0350 |
|
5,605 |
3,113 |
$57K |
| D2160 |
|
546 |
419 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,615 |
3,600 |
$43K |
| D9993 |
|
429 |
429 |
$28K |
| D9430 |
|
669 |
658 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
268 |
200 |
$21K |
| D2332 |
|
211 |
155 |
$17K |
| D0602 |
|
1,094 |
1,093 |
$16K |
| D2140 |
|
296 |
208 |
$16K |
| D1320 |
|
424 |
423 |
$4K |
| D2331 |
|
42 |
31 |
$3K |