| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,952 |
12,900 |
$650K |
| D0120 |
Periodic oral evaluation - established patient |
6,609 |
6,592 |
$445K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,900 |
1,299 |
$341K |
| D1310 |
|
7,322 |
7,298 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,636 |
4,606 |
$309K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,763 |
12,712 |
$274K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,734 |
1,238 |
$267K |
| D1351 |
Sealant - per tooth |
5,166 |
1,317 |
$193K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,977 |
8,722 |
$151K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,108 |
2,096 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,184 |
1,244 |
$122K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,619 |
2,529 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,485 |
883 |
$97K |
| D0603 |
|
5,302 |
5,286 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,166 |
724 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
4,681 |
4,653 |
$55K |
| D2140 |
|
831 |
565 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
868 |
857 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,502 |
3,484 |
$41K |
| D1510 |
|
168 |
142 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,587 |
1,584 |
$33K |
| D0602 |
|
1,943 |
1,936 |
$29K |
| D0350 |
|
2,762 |
1,590 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
280 |
$19K |
| D2330 |
|
200 |
114 |
$15K |
| D9430 |
|
444 |
439 |
$14K |
| D2160 |
|
90 |
76 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
27 |
$2K |
| D1320 |
|
197 |
197 |
$2K |
| D2332 |
|
21 |
12 |
$2K |