| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,433 |
6,412 |
$330K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,379 |
1,411 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
3,488 |
3,482 |
$234K |
| D1310 |
|
3,448 |
3,437 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,822 |
$123K |
| D1351 |
Sealant - per tooth |
2,856 |
895 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,581 |
4,485 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,925 |
2,913 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,524 |
1,404 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
596 |
303 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
783 |
781 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
883 |
402 |
$51K |
| D0350 |
|
2,324 |
1,846 |
$50K |
| D0603 |
|
3,241 |
3,230 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
394 |
212 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,174 |
3,164 |
$44K |
| D2332 |
|
490 |
253 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,291 |
3,211 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
369 |
216 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
373 |
173 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
308 |
$15K |
| D0274 |
Bitewings - four radiographic images |
606 |
604 |
$13K |
| D2330 |
|
156 |
81 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
163 |
70 |
$11K |
| D1320 |
|
752 |
752 |
$7K |
| D0272 |
Bitewings - two radiographic images |
617 |
615 |
$7K |
| D7111 |
|
90 |
46 |
$5K |
| D2331 |
|
37 |
25 |
$3K |
| D9430 |
|
85 |
85 |
$3K |
| D9993 |
|
34 |
34 |
$2K |
| D2140 |
|
28 |
12 |
$2K |
| D0601 |
|
56 |
56 |
$825.00 |