| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,948 |
20,864 |
$983K |
| D0120 |
Periodic oral evaluation - established patient |
11,612 |
11,560 |
$777K |
| D1310 |
|
13,871 |
13,819 |
$626K |
| D1206 |
Topical application of fluoride varnish |
20,816 |
20,733 |
$433K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,458 |
4,450 |
$306K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,519 |
6,256 |
$259K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,858 |
2,367 |
$243K |
| D9993 |
|
3,137 |
3,135 |
$201K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,587 |
2,583 |
$180K |
| D1351 |
Sealant - per tooth |
5,633 |
2,000 |
$178K |
| D0603 |
|
10,005 |
9,973 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,665 |
1,742 |
$146K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,244 |
785 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,625 |
10,618 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,183 |
877 |
$91K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
835 |
505 |
$80K |
| D0272 |
Bitewings - two radiographic images |
5,729 |
5,707 |
$67K |
| D2330 |
|
704 |
214 |
$52K |
| D0601 |
|
3,170 |
3,159 |
$47K |
| D9430 |
|
1,385 |
1,355 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,725 |
3,682 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
233 |
$19K |
| D0274 |
Bitewings - four radiographic images |
842 |
842 |
$17K |
| D0330 |
Panoramic radiographic image |
520 |
515 |
$15K |
| D9920 |
|
70 |
70 |
$10K |
| D1510 |
|
36 |
31 |
$8K |
| D1354 |
|
114 |
27 |
$648.00 |
| D0350 |
|
50 |
14 |
$412.80 |