| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,663 |
16,587 |
$839K |
| D0120 |
Periodic oral evaluation - established patient |
7,786 |
7,767 |
$528K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,034 |
6,981 |
$465K |
| D1310 |
|
10,748 |
10,701 |
$427K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,440 |
3,180 |
$414K |
| D1206 |
Topical application of fluoride varnish |
15,582 |
15,532 |
$354K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71,596 |
14,047 |
$285K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,087 |
1,271 |
$245K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,273 |
3,257 |
$222K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,967 |
4,691 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,578 |
1,751 |
$143K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,457 |
1,048 |
$142K |
| D0603 |
|
7,853 |
7,822 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,101 |
1,243 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
9,391 |
9,276 |
$108K |
| D1351 |
Sealant - per tooth |
2,282 |
683 |
$86K |
| D2330 |
|
1,057 |
492 |
$81K |
| D1510 |
|
347 |
327 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
855 |
624 |
$66K |
| D0272 |
Bitewings - two radiographic images |
4,514 |
4,500 |
$52K |
| D9430 |
|
1,324 |
1,285 |
$41K |
| D0602 |
|
2,755 |
2,741 |
$41K |
| D2335 |
|
295 |
171 |
$34K |
| D0350 |
|
2,893 |
1,600 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,287 |
1,272 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
905 |
$24K |
| D2332 |
|
202 |
131 |
$16K |
| D2390 |
|
76 |
36 |
$7K |
| D9920 |
|
29 |
29 |
$4K |
| D0601 |
|
25 |
25 |
$375.00 |
| D9993 |
|
13 |
13 |
$0.00 |