| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,619 |
10,564 |
$337K |
| D0274 |
Bitewings - four radiographic images |
11,198 |
11,153 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,654 |
2,708 |
$258K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,367 |
1,848 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,660 |
6,643 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,885 |
1,723 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
6,991 |
6,940 |
$159K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,317 |
587 |
$156K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,306 |
1,369 |
$155K |
| D4346 |
|
1,267 |
1,262 |
$151K |
| D1206 |
Topical application of fluoride varnish |
7,706 |
7,677 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,018 |
4,937 |
$134K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,318 |
560 |
$105K |
| D1351 |
Sealant - per tooth |
4,257 |
1,538 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,623 |
5,586 |
$101K |
| D0330 |
Panoramic radiographic image |
2,601 |
2,588 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
806 |
448 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,114 |
2,057 |
$62K |
| D1110 |
Prophylaxis - adult |
1,257 |
1,250 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,803 |
4,671 |
$54K |
| D2160 |
|
370 |
274 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,832 |
2,476 |
$28K |
| D2331 |
|
260 |
182 |
$23K |
| D9248 |
|
926 |
906 |
$22K |
| D7111 |
|
428 |
284 |
$21K |
| D2332 |
|
141 |
74 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
115 |
$15K |
| D2140 |
|
281 |
182 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
225 |
$11K |
| D2335 |
|
44 |
30 |
$6K |
| D2330 |
|
57 |
37 |
$4K |
| D2940 |
|
60 |
53 |
$3K |