| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,629 |
22,470 |
$996K |
| D0120 |
Periodic oral evaluation - established patient |
15,298 |
15,173 |
$980K |
| D1310 |
|
12,946 |
12,843 |
$585K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,493 |
4,278 |
$490K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,047 |
22,889 |
$423K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,658 |
5,645 |
$380K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67,338 |
17,320 |
$295K |
| D9993 |
|
4,572 |
4,569 |
$290K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,273 |
1,248 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,045 |
2,547 |
$212K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,002 |
2,983 |
$198K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,393 |
2,103 |
$189K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,814 |
1,043 |
$176K |
| D0350 |
|
14,683 |
7,537 |
$172K |
| D0603 |
|
10,804 |
10,715 |
$159K |
| D1351 |
Sealant - per tooth |
4,099 |
1,628 |
$129K |
| D9248 |
|
3,827 |
3,664 |
$126K |
| D2330 |
|
1,459 |
894 |
$109K |
| D0272 |
Bitewings - two radiographic images |
8,481 |
8,433 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,292 |
2,174 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
2,155 |
2,150 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
7,058 |
6,964 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,632 |
2,619 |
$54K |
| D9430 |
|
1,686 |
1,633 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
673 |
548 |
$52K |
| D1110 |
Prophylaxis - adult |
491 |
491 |
$43K |
| D0602 |
|
1,922 |
1,913 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
681 |
681 |
$24K |
| D0330 |
Panoramic radiographic image |
717 |
717 |
$21K |
| D9920 |
|
109 |
109 |
$10K |
| D2332 |
|
51 |
36 |
$4K |
| D1354 |
|
153 |
66 |
$2K |
| D1999 |
|
3,520 |
3,212 |
$2K |
| D0270 |
|
39 |
38 |
$190.00 |
| D9110 |
|
12 |
12 |
$173.25 |