| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,067 |
18,020 |
$780K |
| D0120 |
Periodic oral evaluation - established patient |
12,188 |
12,154 |
$749K |
| D1310 |
|
9,245 |
9,228 |
$419K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,032 |
1,598 |
$266K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,882 |
3,867 |
$255K |
| D1206 |
Topical application of fluoride varnish |
15,542 |
15,497 |
$252K |
| D1351 |
Sealant - per tooth |
7,993 |
2,109 |
$235K |
| D9993 |
|
3,521 |
3,521 |
$221K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,880 |
14,063 |
$220K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,565 |
2,563 |
$171K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
921 |
504 |
$107K |
| D0272 |
Bitewings - two radiographic images |
8,847 |
8,821 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,364 |
2,292 |
$93K |
| D0603 |
|
5,846 |
5,840 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,207 |
707 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,070 |
2,069 |
$54K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
483 |
266 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
843 |
455 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,297 |
2,287 |
$45K |
| D9430 |
|
1,337 |
1,297 |
$43K |
| D0601 |
|
2,603 |
2,592 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,992 |
2,965 |
$32K |
| D0350 |
|
1,537 |
702 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
37 |
37 |
$11K |
| D0602 |
|
517 |
517 |
$8K |
| D0330 |
Panoramic radiographic image |
222 |
222 |
$6K |
| D1320 |
|
503 |
503 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
80 |
$4K |
| D1330 |
|
138 |
138 |
$0.00 |