| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,189 |
9,150 |
$513K |
| D1120 |
Prophylaxis - child |
11,687 |
11,631 |
$453K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,219 |
2,155 |
$272K |
| D0230 |
Intraoral - periapical each additional radiographic image |
49,617 |
9,925 |
$203K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,269 |
3,871 |
$160K |
| D1310 |
|
3,360 |
3,343 |
$151K |
| D1351 |
Sealant - per tooth |
4,387 |
1,551 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
10,197 |
10,035 |
$120K |
| D9993 |
|
1,903 |
1,892 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,049 |
9,010 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,608 |
1,603 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,448 |
820 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,461 |
901 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,235 |
2,223 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
693 |
689 |
$42K |
| D0350 |
|
4,237 |
2,387 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
366 |
194 |
$42K |
| D0603 |
|
2,606 |
2,591 |
$38K |
| D9430 |
|
1,058 |
997 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
395 |
271 |
$30K |
| D0601 |
|
611 |
609 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
46 |
$8K |
| D2330 |
|
40 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
220 |
220 |
$3K |