| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,509 |
12,334 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
17,123 |
16,910 |
$409K |
| D1206 |
Topical application of fluoride varnish |
15,020 |
14,779 |
$309K |
| D1110 |
Prophylaxis - adult |
7,140 |
7,005 |
$307K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,501 |
2,572 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,322 |
2,066 |
$243K |
| D1351 |
Sealant - per tooth |
6,787 |
2,434 |
$196K |
| D0274 |
Bitewings - four radiographic images |
6,898 |
6,780 |
$186K |
| D0330 |
Panoramic radiographic image |
2,984 |
2,930 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,841 |
4,781 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,580 |
3,544 |
$72K |
| D1353 |
|
2,294 |
786 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
852 |
563 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,393 |
1,356 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
287 |
168 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
256 |
186 |
$21K |
| D1354 |
|
3,276 |
476 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
543 |
533 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
749 |
729 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
71 |
46 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
159 |
157 |
$4K |
| D4355 |
|
41 |
38 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
67 |
$2K |
| D1510 |
|
13 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |