| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
17,271 |
17,227 |
$721K |
| D0120 |
Periodic oral evaluation - established patient |
11,272 |
11,240 |
$671K |
| D1310 |
|
7,697 |
7,680 |
$348K |
| D0230 |
Intraoral - periapical each additional radiographic image |
80,418 |
16,764 |
$333K |
| D1206 |
Topical application of fluoride varnish |
14,644 |
14,603 |
$286K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,612 |
3,608 |
$233K |
| D0220 |
Intraoral - periapical first radiographic image |
18,080 |
17,810 |
$212K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,126 |
3,120 |
$198K |
| D9993 |
|
6,895 |
6,878 |
$197K |
| D0603 |
|
6,731 |
6,714 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
865 |
144 |
$98K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
692 |
130 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,105 |
1,105 |
$50K |
| D1351 |
Sealant - per tooth |
1,194 |
293 |
$45K |
| D9430 |
|
988 |
971 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,311 |
2,311 |
$20K |
| D0602 |
|
743 |
743 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
253 |
251 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
13 |
$2K |
| D0350 |
|
35 |
24 |
$403.20 |
| D9920 |
|
101 |
101 |
$140.00 |