| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,524 |
24,454 |
$938K |
| D0120 |
Periodic oral evaluation - established patient |
10,675 |
10,653 |
$615K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,607 |
12,909 |
$532K |
| D1310 |
|
9,797 |
9,770 |
$442K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,365 |
24,295 |
$366K |
| D9430 |
|
11,078 |
10,184 |
$349K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,877 |
2,328 |
$314K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,849 |
2,929 |
$312K |
| D9993 |
|
4,732 |
4,732 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,601 |
4,589 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,120 |
2,737 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,109 |
2,928 |
$220K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,393 |
11,402 |
$184K |
| D1351 |
Sealant - per tooth |
3,871 |
1,191 |
$119K |
| D0272 |
Bitewings - two radiographic images |
8,901 |
8,884 |
$103K |
| D0603 |
|
6,048 |
6,030 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,799 |
1,334 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,929 |
5,847 |
$69K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
741 |
606 |
$68K |
| D0602 |
|
3,357 |
3,349 |
$49K |
| D2140 |
|
760 |
547 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
604 |
603 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,772 |
1,766 |
$29K |
| D2330 |
|
317 |
222 |
$23K |
| D0350 |
|
2,332 |
1,816 |
$22K |
| D0330 |
Panoramic radiographic image |
633 |
633 |
$18K |
| D1510 |
|
29 |
28 |
$3K |
| D1999 |
|
1,780 |
1,767 |
$2K |
| D2160 |
|
13 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$936.80 |
| D9920 |
|
14 |
14 |
$0.00 |