| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,336 |
9,280 |
$461K |
| D0120 |
Periodic oral evaluation - established patient |
5,129 |
5,098 |
$359K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,350 |
3,334 |
$221K |
| D1351 |
Sealant - per tooth |
5,780 |
1,692 |
$213K |
| D1310 |
|
4,672 |
4,639 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,836 |
2,063 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,238 |
9,176 |
$181K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,671 |
3,308 |
$147K |
| D0350 |
|
15,314 |
6,366 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,403 |
6,887 |
$99K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
765 |
509 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,530 |
1,080 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,552 |
1,164 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,084 |
1,076 |
$73K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
606 |
419 |
$60K |
| D0603 |
|
3,509 |
3,489 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,243 |
2,230 |
$36K |
| D2330 |
|
419 |
223 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,526 |
2,513 |
$29K |
| D9993 |
|
402 |
402 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,128 |
2,098 |
$25K |
| D0330 |
Panoramic radiographic image |
825 |
809 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
286 |
234 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
370 |
$18K |
| D9430 |
|
467 |
455 |
$14K |
| D0602 |
|
944 |
936 |
$14K |
| D2331 |
|
58 |
38 |
$5K |
| D2332 |
|
15 |
12 |
$1K |
| D0270 |
|
64 |
61 |
$315.00 |
| D0601 |
|
13 |
13 |
$180.00 |
| D9920 |
|
33 |
30 |
$140.00 |