| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,728 |
4,708 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
2,855 |
2,841 |
$198K |
| D1206 |
Topical application of fluoride varnish |
4,500 |
4,480 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,189 |
1,186 |
$81K |
| D1310 |
|
1,740 |
1,728 |
$78K |
| D1351 |
Sealant - per tooth |
1,953 |
589 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
973 |
384 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,587 |
2,576 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,552 |
3,092 |
$29K |
| D9993 |
|
1,722 |
1,710 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
300 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
456 |
430 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
258 |
152 |
$14K |
| D0602 |
|
892 |
885 |
$13K |
| D9430 |
|
365 |
343 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
133 |
$11K |
| D0350 |
|
784 |
665 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
804 |
784 |
$10K |
| D0274 |
Bitewings - four radiographic images |
306 |
304 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
50 |
24 |
$5K |
| D0603 |
|
216 |
216 |
$3K |
| D0601 |
|
175 |
175 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$2K |