| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
28,875 |
26,331 |
$752K |
| D0120 |
Periodic oral evaluation - established patient |
32,957 |
30,060 |
$576K |
| D1206 |
Topical application of fluoride varnish |
27,755 |
25,345 |
$575K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,318 |
4,273 |
$398K |
| D1999 |
|
20,956 |
19,054 |
$391K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,099 |
3,293 |
$348K |
| D1351 |
Sealant - per tooth |
16,612 |
4,616 |
$326K |
| D0272 |
Bitewings - two radiographic images |
18,961 |
17,342 |
$311K |
| D1110 |
Prophylaxis - adult |
8,194 |
7,440 |
$282K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,272 |
11,908 |
$267K |
| D0330 |
Panoramic radiographic image |
6,358 |
5,762 |
$265K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,716 |
1,596 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,854 |
2,469 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,973 |
9,935 |
$144K |
| D1354 |
|
7,051 |
2,261 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,327 |
3,829 |
$99K |
| D0240 |
|
6,368 |
3,477 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,553 |
3,171 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,324 |
963 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,352 |
2,109 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,685 |
3,202 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,511 |
1,336 |
$30K |
| D2335 |
|
395 |
136 |
$29K |
| D2330 |
|
438 |
275 |
$21K |
| D2140 |
|
130 |
106 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
34 |
30 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$249.09 |