| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,224 |
3,198 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
1,999 |
1,979 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,227 |
741 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,777 |
1,621 |
$70K |
| D1310 |
|
1,463 |
1,450 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,161 |
3,174 |
$65K |
| D1206 |
Topical application of fluoride varnish |
3,125 |
3,102 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
792 |
789 |
$55K |
| D1351 |
Sealant - per tooth |
965 |
305 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,848 |
1,831 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
277 |
180 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,201 |
1,139 |
$14K |
| D0603 |
|
817 |
807 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
167 |
$12K |
| D0350 |
|
1,020 |
622 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
78 |
52 |
$9K |
| D0274 |
Bitewings - four radiographic images |
417 |
415 |
$9K |
| D9993 |
|
143 |
142 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
68 |
$5K |
| D0601 |
|
312 |
311 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D9430 |
|
26 |
24 |
$800.00 |
| D0602 |
|
40 |
40 |
$600.00 |