| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,285 |
8,266 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
4,381 |
4,370 |
$305K |
| D1310 |
|
4,253 |
4,238 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
2,406 |
$162K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,206 |
7,191 |
$149K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,975 |
1,968 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,396 |
5,275 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,053 |
1,059 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,744 |
1,517 |
$69K |
| D0603 |
|
3,947 |
3,933 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
930 |
495 |
$49K |
| D1351 |
Sealant - per tooth |
1,307 |
478 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,264 |
3,259 |
$38K |
| D0350 |
|
3,599 |
1,198 |
$33K |
| D9430 |
|
989 |
944 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
210 |
120 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,616 |
1,598 |
$19K |
| D1206 |
Topical application of fluoride varnish |
660 |
655 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
384 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
222 |
124 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
120 |
64 |
$12K |
| D0274 |
Bitewings - four radiographic images |
519 |
517 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
42 |
$4K |
| D0601 |
|
164 |
164 |
$2K |
| D1354 |
|
366 |
85 |
$0.00 |