| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,388 |
16,322 |
$782K |
| D0120 |
Periodic oral evaluation - established patient |
9,610 |
9,571 |
$641K |
| D1310 |
|
9,075 |
9,039 |
$410K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,076 |
3,017 |
$399K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,527 |
4,508 |
$305K |
| D1206 |
Topical application of fluoride varnish |
13,683 |
13,620 |
$280K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,084 |
972 |
$244K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,519 |
5,175 |
$221K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,509 |
2,005 |
$196K |
| D1351 |
Sealant - per tooth |
5,268 |
1,626 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,498 |
13,225 |
$168K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,663 |
780 |
$162K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,884 |
1,879 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,330 |
1,438 |
$122K |
| D0603 |
|
7,552 |
7,519 |
$111K |
| D0272 |
Bitewings - two radiographic images |
8,779 |
8,738 |
$102K |
| D9993 |
|
1,241 |
1,241 |
$77K |
| D0350 |
|
4,620 |
2,566 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,790 |
3,696 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,972 |
1,971 |
$39K |
| D9430 |
|
1,199 |
1,162 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
739 |
736 |
$25K |
| D0340 |
|
504 |
499 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,058 |
1,056 |
$22K |
| D0330 |
Panoramic radiographic image |
735 |
729 |
$21K |
| D1510 |
|
30 |
26 |
$5K |
| D0601 |
|
354 |
354 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
49 |
$5K |
| D0602 |
|
294 |
294 |
$4K |
| D2330 |
|
40 |
26 |
$3K |
| D1354 |
|
44 |
15 |
$372.00 |
| D0270 |
|
15 |
15 |
$75.00 |