| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,239 |
16,156 |
$774K |
| D0120 |
Periodic oral evaluation - established patient |
9,447 |
9,401 |
$656K |
| D1310 |
|
8,859 |
8,814 |
$382K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,010 |
15,925 |
$321K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,413 |
4,381 |
$300K |
| D1351 |
Sealant - per tooth |
7,665 |
2,005 |
$271K |
| D0350 |
|
26,605 |
8,300 |
$214K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,558 |
12,638 |
$174K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,453 |
2,448 |
$168K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,400 |
1,041 |
$164K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,397 |
3,179 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,405 |
1,582 |
$134K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,224 |
912 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,802 |
1,428 |
$117K |
| D0274 |
Bitewings - four radiographic images |
4,092 |
4,061 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,421 |
1,158 |
$76K |
| D0603 |
|
4,740 |
4,714 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,146 |
5,065 |
$60K |
| D9993 |
|
758 |
758 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,729 |
3,706 |
$41K |
| D0601 |
|
2,800 |
2,786 |
$39K |
| D9430 |
|
1,118 |
1,082 |
$36K |
| D1510 |
|
114 |
109 |
$23K |
| D0602 |
|
840 |
840 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$3K |
| D0270 |
|
171 |
170 |
$840.00 |