| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,835 |
20,696 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
12,447 |
12,363 |
$887K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,562 |
2,157 |
$662K |
| D1310 |
|
11,487 |
11,390 |
$516K |
| D1206 |
Topical application of fluoride varnish |
20,166 |
20,026 |
$434K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,551 |
5,507 |
$382K |
| D1351 |
Sealant - per tooth |
9,724 |
3,450 |
$348K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,952 |
2,762 |
$330K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,729 |
3,713 |
$256K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,080 |
2,523 |
$220K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,715 |
1,417 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,763 |
3,598 |
$150K |
| D2330 |
|
1,709 |
1,005 |
$132K |
| D0603 |
|
8,840 |
8,761 |
$129K |
| D0272 |
Bitewings - two radiographic images |
8,144 |
8,077 |
$96K |
| D0350 |
|
7,917 |
4,491 |
$79K |
| D1354 |
|
5,588 |
2,362 |
$63K |
| D0330 |
Panoramic radiographic image |
1,987 |
1,959 |
$57K |
| D9993 |
|
962 |
960 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,023 |
5,249 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,494 |
1,483 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,858 |
1,835 |
$22K |
| D0602 |
|
1,442 |
1,435 |
$21K |
| D9420 |
|
261 |
237 |
$18K |
| D0601 |
|
994 |
985 |
$15K |
| D2390 |
|
95 |
39 |
$10K |
| D9430 |
|
256 |
252 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
736 |
736 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
71 |
53 |
$7K |
| D1510 |
|
29 |
24 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$576.00 |