| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,721 |
9,676 |
$462K |
| D0120 |
Periodic oral evaluation - established patient |
6,216 |
6,183 |
$451K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,311 |
1,736 |
$213K |
| D1310 |
|
4,573 |
4,555 |
$209K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,845 |
2,838 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,358 |
9,314 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,083 |
8,101 |
$156K |
| D1351 |
Sealant - per tooth |
3,558 |
1,280 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,904 |
2,795 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,864 |
1,127 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
7,742 |
7,677 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,500 |
806 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
637 |
391 |
$74K |
| D0145 |
Oral evaluation for a patient under three years of age |
999 |
997 |
$68K |
| D0603 |
|
4,501 |
4,484 |
$67K |
| D9993 |
|
958 |
958 |
$56K |
| D0350 |
|
4,486 |
2,232 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
205 |
$20K |
| D9430 |
|
572 |
555 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
138 |
79 |
$13K |
| D0272 |
Bitewings - two radiographic images |
849 |
845 |
$10K |
| D2330 |
|
107 |
59 |
$8K |