| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,807 |
17,720 |
$923K |
| D0120 |
Periodic oral evaluation - established patient |
8,842 |
8,802 |
$637K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,886 |
6,854 |
$468K |
| D1351 |
Sealant - per tooth |
11,878 |
3,997 |
$454K |
| D1310 |
|
8,602 |
8,557 |
$391K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,348 |
2,550 |
$358K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,698 |
1,149 |
$321K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,125 |
15,014 |
$311K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,375 |
7,234 |
$295K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,291 |
1,005 |
$225K |
| D1206 |
Topical application of fluoride varnish |
7,149 |
7,109 |
$222K |
| D2140 |
|
3,770 |
1,994 |
$206K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,184 |
1,890 |
$182K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,297 |
2,286 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,208 |
10,167 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
9,417 |
9,358 |
$113K |
| D0350 |
|
5,108 |
4,540 |
$87K |
| D0603 |
|
5,701 |
5,676 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,744 |
1,736 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,060 |
3,043 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
908 |
493 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,975 |
2,951 |
$36K |
| D0602 |
|
2,214 |
2,200 |
$33K |
| D2160 |
|
389 |
260 |
$31K |
| D1320 |
|
2,566 |
2,566 |
$26K |
| D2330 |
|
261 |
153 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
197 |
$18K |
| D1510 |
|
40 |
31 |
$8K |
| D9430 |
|
163 |
162 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
16 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |