| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,638 |
6,598 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
4,264 |
4,226 |
$288K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,620 |
6,579 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,601 |
915 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,465 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,487 |
2,259 |
$97K |
| D1310 |
|
1,728 |
1,722 |
$65K |
| D1351 |
Sealant - per tooth |
1,629 |
546 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,995 |
3,444 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
437 |
437 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,148 |
2,136 |
$25K |
| D9993 |
|
1,525 |
1,519 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
323 |
207 |
$18K |
| D9430 |
|
511 |
482 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
105 |
81 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
86 |
$11K |
| D0601 |
|
855 |
853 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
113 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,164 |
1,091 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
80 |
64 |
$8K |
| D0603 |
|
446 |
445 |
$6K |
| D0274 |
Bitewings - four radiographic images |
159 |
159 |
$3K |
| D0330 |
Panoramic radiographic image |
71 |
70 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |
| D1330 |
|
13 |
13 |
$0.00 |