| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,270 |
12,213 |
$545K |
| D0120 |
Periodic oral evaluation - established patient |
7,475 |
7,429 |
$490K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,229 |
2,366 |
$346K |
| D1310 |
|
5,194 |
5,170 |
$228K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,345 |
3,338 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,257 |
12,198 |
$208K |
| D1351 |
Sealant - per tooth |
5,261 |
1,641 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,941 |
1,552 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,001 |
6,190 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
881 |
543 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,620 |
2,556 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,223 |
830 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,381 |
1,373 |
$93K |
| D2335 |
|
775 |
356 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,456 |
934 |
$78K |
| D0603 |
|
4,957 |
4,935 |
$73K |
| D9993 |
|
1,130 |
1,126 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
5,159 |
5,083 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
538 |
330 |
$53K |
| D9430 |
|
1,223 |
1,195 |
$39K |
| D0350 |
|
3,516 |
1,878 |
$36K |
| D2330 |
|
283 |
181 |
$22K |
| D0274 |
Bitewings - four radiographic images |
983 |
980 |
$21K |
| D9248 |
|
530 |
529 |
$18K |
| D0272 |
Bitewings - two radiographic images |
331 |
330 |
$4K |
| D2332 |
|
16 |
12 |
$1K |
| D0602 |
|
67 |
67 |
$990.00 |
| D2331 |
|
12 |
12 |
$961.08 |