| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,255 |
3,252 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,609 |
1,606 |
$103K |
| D1310 |
|
1,963 |
1,961 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,133 |
586 |
$75K |
| D1206 |
Topical application of fluoride varnish |
3,251 |
3,248 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,042 |
1,042 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
887 |
502 |
$50K |
| D1351 |
Sealant - per tooth |
1,205 |
424 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,455 |
2,139 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
351 |
225 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,031 |
982 |
$41K |
| D0145 |
Oral evaluation for a patient under three years of age |
568 |
568 |
$36K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
230 |
167 |
$23K |
| D0603 |
|
1,334 |
1,332 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
183 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,037 |
1,033 |
$12K |
| D0272 |
Bitewings - two radiographic images |
996 |
995 |
$12K |
| D0350 |
|
846 |
497 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
56 |
$6K |
| D0601 |
|
370 |
370 |
$6K |
| D9430 |
|
105 |
105 |
$3K |
| D0274 |
Bitewings - four radiographic images |
148 |
148 |
$3K |
| D0602 |
|
141 |
141 |
$2K |