| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,402 |
9,349 |
$471K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,831 |
1,127 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
4,351 |
4,325 |
$302K |
| D1351 |
Sealant - per tooth |
7,952 |
2,589 |
$298K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,837 |
1,101 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,057 |
4,032 |
$270K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,488 |
1,739 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,456 |
9,403 |
$195K |
| D2330 |
|
2,408 |
1,205 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,153 |
1,765 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,847 |
7,907 |
$162K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,082 |
3,965 |
$161K |
| D7111 |
|
2,108 |
1,365 |
$118K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,660 |
1,652 |
$112K |
| D2140 |
|
1,913 |
954 |
$102K |
| D1310 |
|
5,649 |
5,607 |
$83K |
| D0350 |
|
7,511 |
3,529 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,513 |
5,418 |
$65K |
| D0603 |
|
4,213 |
4,179 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
828 |
561 |
$54K |
| D1510 |
|
223 |
190 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
715 |
715 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,437 |
1,424 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,354 |
2,344 |
$28K |
| D9430 |
|
878 |
825 |
$27K |
| D2160 |
|
311 |
244 |
$24K |
| D2331 |
|
242 |
182 |
$18K |
| D0601 |
|
1,148 |
1,148 |
$17K |
| D1320 |
|
780 |
779 |
$8K |
| D1110 |
Prophylaxis - adult |
52 |
52 |
$5K |
| D0602 |
|
269 |
265 |
$4K |
| D9920 |
|
19 |
19 |
$1K |