| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
25,601 |
25,584 |
$926K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,101 |
6,350 |
$554K |
| D0120 |
Periodic oral evaluation - established patient |
20,786 |
20,775 |
$455K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,270 |
22,258 |
$259K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,753 |
2,316 |
$248K |
| D0272 |
Bitewings - two radiographic images |
19,041 |
19,022 |
$216K |
| D1351 |
Sealant - per tooth |
6,327 |
2,369 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,931 |
2,982 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,300 |
7,298 |
$169K |
| D1206 |
Topical application of fluoride varnish |
5,772 |
5,768 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,071 |
2,370 |
$138K |
| D1110 |
Prophylaxis - adult |
2,962 |
2,960 |
$114K |
| D9920 |
|
4,071 |
3,838 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
9,389 |
9,319 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
829 |
745 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,274 |
2,156 |
$55K |
| D0240 |
|
2,731 |
2,521 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,497 |
2,473 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,781 |
6,770 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
490 |
444 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,488 |
1,486 |
$28K |
| D1354 |
|
920 |
359 |
$12K |
| D0603 |
|
1,169 |
1,168 |
$11K |
| D0330 |
Panoramic radiographic image |
355 |
355 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
163 |
163 |
$5K |
| D2335 |
|
37 |
31 |
$3K |
| D0270 |
|
263 |
260 |
$2K |
| D0602 |
|
107 |
107 |
$1K |
| D9310 |
|
38 |
38 |
$710.00 |
| D2330 |
|
18 |
15 |
$698.59 |
| D9995 |
|
17 |
17 |
$361.32 |
| D1320 |
|
103 |
102 |
$340.12 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$306.09 |
| D1999 |
|
140 |
138 |
$0.00 |
| D1330 |
|
69 |
68 |
$0.00 |
| D1310 |
|
69 |
68 |
$0.00 |