| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,071 |
13,968 |
$591K |
| D0120 |
Periodic oral evaluation - established patient |
8,069 |
8,005 |
$528K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,478 |
3,362 |
$365K |
| D1310 |
|
7,212 |
7,140 |
$327K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,659 |
4,631 |
$310K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,622 |
13,268 |
$270K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,582 |
5,980 |
$261K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,106 |
2,565 |
$222K |
| D9993 |
|
2,903 |
2,903 |
$185K |
| D1351 |
Sealant - per tooth |
5,415 |
2,174 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,169 |
11,075 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,557 |
1,653 |
$145K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,132 |
891 |
$135K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,001 |
1,985 |
$133K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,077 |
838 |
$106K |
| D0350 |
|
8,844 |
4,084 |
$98K |
| D0603 |
|
4,571 |
4,516 |
$68K |
| D0272 |
Bitewings - two radiographic images |
6,015 |
5,973 |
$66K |
| D2330 |
|
738 |
465 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,240 |
4,168 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,283 |
2,280 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,024 |
2,007 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
535 |
436 |
$43K |
| D9430 |
|
739 |
718 |
$24K |
| D0330 |
Panoramic radiographic image |
782 |
782 |
$23K |
| D0601 |
|
1,451 |
1,441 |
$22K |
| D0602 |
|
706 |
702 |
$10K |
| D1510 |
|
69 |
66 |
$8K |
| D2335 |
|
40 |
24 |
$5K |
| D1354 |
|
164 |
41 |
$2K |
| D7111 |
|
19 |
15 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$624.00 |