| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,541 |
5,501 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
3,066 |
3,050 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,984 |
1,211 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,959 |
1,949 |
$131K |
| D1310 |
|
2,367 |
2,336 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,437 |
2,119 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,044 |
3,570 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,303 |
867 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,828 |
2,816 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
898 |
603 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
403 |
287 |
$47K |
| D9993 |
|
1,463 |
1,436 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,640 |
2,612 |
$35K |
| D1351 |
Sealant - per tooth |
717 |
218 |
$26K |
| D9430 |
|
774 |
735 |
$25K |
| D0601 |
|
1,133 |
1,119 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,341 |
1,319 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
221 |
209 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,271 |
1,268 |
$15K |
| D0603 |
|
719 |
704 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
84 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
29 |
$3K |
| D2332 |
|
21 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$1K |
| D2330 |
|
14 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$690.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |