| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,146 |
9,110 |
$452K |
| D0120 |
Periodic oral evaluation - established patient |
4,310 |
4,286 |
$295K |
| D1310 |
|
5,161 |
5,137 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,355 |
3,347 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,673 |
8,640 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,644 |
1,787 |
$176K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,265 |
3,024 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,874 |
6,824 |
$124K |
| D0350 |
|
14,469 |
5,298 |
$110K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,418 |
1,415 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,594 |
1,113 |
$86K |
| D1351 |
Sealant - per tooth |
2,301 |
694 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,106 |
714 |
$63K |
| D0603 |
|
4,051 |
4,026 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
433 |
321 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,894 |
2,856 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,900 |
1,895 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,895 |
1,883 |
$22K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
187 |
144 |
$18K |
| D9993 |
|
304 |
304 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
177 |
150 |
$14K |
| D9430 |
|
370 |
367 |
$12K |
| D0602 |
|
525 |
524 |
$8K |
| D0330 |
Panoramic radiographic image |
255 |
255 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
108 |
$5K |
| D0601 |
|
117 |
117 |
$2K |
| D2330 |
|
20 |
14 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |