| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,185 |
16,127 |
$751K |
| D0120 |
Periodic oral evaluation - established patient |
10,662 |
10,632 |
$715K |
| D1310 |
|
8,404 |
8,376 |
$384K |
| D1351 |
Sealant - per tooth |
8,216 |
2,527 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,795 |
3,785 |
$259K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,361 |
12,571 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,723 |
2,189 |
$249K |
| D9993 |
|
2,405 |
2,405 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,725 |
1,649 |
$148K |
| D1206 |
Topical application of fluoride varnish |
5,792 |
5,769 |
$146K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,157 |
10,131 |
$130K |
| D7111 |
|
2,101 |
1,429 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
8,689 |
8,550 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,521 |
2,377 |
$101K |
| D0603 |
|
6,147 |
6,131 |
$92K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,158 |
1,158 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
690 |
359 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
564 |
294 |
$67K |
| D0350 |
|
3,624 |
3,321 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,658 |
3,652 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
609 |
281 |
$40K |
| D2330 |
|
405 |
241 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
611 |
611 |
$29K |
| D0601 |
|
1,479 |
1,472 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
1,005 |
$22K |
| D9430 |
|
529 |
523 |
$17K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
15 |
13 |
$14K |
| D1320 |
|
1,377 |
1,377 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
94 |
$9K |
| D1510 |
|
34 |
29 |
$7K |
| D2140 |
|
35 |
25 |
$2K |
| D2160 |
|
21 |
14 |
$2K |
| D9222 |
|
13 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
17 |
$1K |
| D9610 |
|
13 |
13 |
$1K |