| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,799 |
10,714 |
$557K |
| D0120 |
Periodic oral evaluation - established patient |
5,940 |
5,909 |
$394K |
| D1310 |
|
6,405 |
6,354 |
$291K |
| D1206 |
Topical application of fluoride varnish |
10,306 |
10,218 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,257 |
3,229 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,994 |
1,699 |
$196K |
| D1351 |
Sealant - per tooth |
5,045 |
1,465 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,430 |
908 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,602 |
3,407 |
$142K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,797 |
1,773 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,452 |
7,726 |
$110K |
| D0603 |
|
5,112 |
5,073 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,029 |
651 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
992 |
692 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,480 |
3,438 |
$41K |
| D3240 |
|
414 |
317 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,219 |
3,195 |
$37K |
| D1510 |
|
174 |
147 |
$34K |
| D0350 |
|
2,947 |
1,597 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,215 |
1,203 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
292 |
209 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
397 |
$18K |
| D9430 |
|
575 |
557 |
$18K |
| D0602 |
|
1,031 |
1,021 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
41 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
86 |
$3K |
| D9993 |
|
40 |
40 |
$3K |
| D0330 |
Panoramic radiographic image |
86 |
86 |
$3K |
| D2330 |
|
20 |
14 |
$2K |
| D1354 |
|
47 |
12 |
$564.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$197.50 |
| D0601 |
|
12 |
12 |
$180.00 |