| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,737 |
12,674 |
$586K |
| D0120 |
Periodic oral evaluation - established patient |
8,106 |
8,058 |
$524K |
| D1310 |
|
7,234 |
7,194 |
$327K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,364 |
1,404 |
$276K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,236 |
12,269 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,518 |
12,456 |
$239K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,480 |
1,917 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,331 |
3,322 |
$225K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,455 |
5,095 |
$217K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,163 |
1,261 |
$210K |
| D1351 |
Sealant - per tooth |
5,963 |
2,206 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,704 |
1,699 |
$153K |
| D9993 |
|
1,903 |
1,901 |
$121K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,588 |
1,581 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
7,854 |
7,433 |
$93K |
| D0603 |
|
5,437 |
5,406 |
$80K |
| D2140 |
|
1,454 |
945 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,373 |
965 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,040 |
555 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,691 |
2,672 |
$58K |
| D0350 |
|
4,838 |
2,948 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,292 |
3,280 |
$39K |
| D2330 |
|
316 |
197 |
$24K |
| D0602 |
|
1,515 |
1,510 |
$23K |
| D1510 |
|
119 |
108 |
$20K |
| D2160 |
|
171 |
144 |
$14K |
| D9430 |
|
301 |
297 |
$10K |
| D1320 |
|
256 |
255 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$97.00 |