| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,010 |
3,999 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,966 |
$129K |
| D1310 |
|
2,430 |
2,418 |
$109K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
850 |
413 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,989 |
3,981 |
$89K |
| D1351 |
Sealant - per tooth |
2,315 |
751 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,366 |
1,361 |
$84K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
735 |
374 |
$72K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,085 |
578 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,164 |
2,953 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,399 |
1,318 |
$55K |
| D2140 |
|
1,018 |
528 |
$55K |
| D0145 |
Oral evaluation for a patient under three years of age |
840 |
839 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
894 |
505 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,320 |
2,305 |
$27K |
| D0603 |
|
1,533 |
1,524 |
$22K |
| D0350 |
|
1,559 |
753 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
306 |
$15K |
| D0602 |
|
869 |
869 |
$13K |
| D0274 |
Bitewings - four radiographic images |
423 |
423 |
$9K |
| D0272 |
Bitewings - two radiographic images |
723 |
723 |
$9K |
| D1510 |
|
16 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$819.00 |