| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,164 |
15,058 |
$751K |
| D0120 |
Periodic oral evaluation - established patient |
9,181 |
9,110 |
$647K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,380 |
1,581 |
$401K |
| D1310 |
|
8,452 |
8,392 |
$384K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,127 |
14,023 |
$296K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,040 |
4,021 |
$277K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,602 |
1,904 |
$240K |
| D1351 |
Sealant - per tooth |
5,884 |
1,616 |
$215K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,042 |
3,446 |
$160K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,264 |
2,254 |
$159K |
| D0603 |
|
6,384 |
6,346 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
933 |
546 |
$92K |
| D0272 |
Bitewings - two radiographic images |
7,820 |
7,748 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,515 |
890 |
$86K |
| D9993 |
|
987 |
987 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,061 |
4,066 |
$47K |
| D1510 |
|
224 |
175 |
$47K |
| D0240 |
|
5,093 |
3,056 |
$43K |
| D9430 |
|
1,255 |
1,213 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,281 |
3,081 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
400 |
$37K |
| D0601 |
|
1,929 |
1,911 |
$29K |
| D0350 |
|
1,993 |
943 |
$19K |
| D0330 |
Panoramic radiographic image |
514 |
495 |
$15K |
| D0274 |
Bitewings - four radiographic images |
775 |
767 |
$15K |
| D2330 |
|
173 |
91 |
$13K |
| D1206 |
Topical application of fluoride varnish |
671 |
671 |
$9K |
| D2331 |
|
17 |
12 |
$1K |