| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,788 |
5,767 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
3,191 |
3,181 |
$213K |
| D1310 |
|
2,960 |
2,948 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,821 |
1,815 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,834 |
915 |
$122K |
| D1351 |
Sealant - per tooth |
2,743 |
904 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,838 |
931 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,471 |
4,442 |
$88K |
| D1206 |
Topical application of fluoride varnish |
2,287 |
2,280 |
$62K |
| D7111 |
|
861 |
523 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,075 |
3,069 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,268 |
3,225 |
$39K |
| D0603 |
|
2,364 |
2,360 |
$35K |
| D0350 |
|
1,946 |
1,659 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
664 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
196 |
105 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
263 |
263 |
$18K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
180 |
76 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
245 |
$12K |
| D0274 |
Bitewings - four radiographic images |
437 |
437 |
$9K |
| D1320 |
|
766 |
766 |
$8K |
| D2330 |
|
84 |
43 |
$6K |
| D0272 |
Bitewings - two radiographic images |
333 |
330 |
$4K |
| D0601 |
|
104 |
104 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |