| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,513 |
5,452 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
3,420 |
3,371 |
$223K |
| D0350 |
|
13,804 |
3,926 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,689 |
1,679 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,265 |
5,208 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,176 |
758 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,035 |
4,832 |
$75K |
| D1310 |
|
1,396 |
1,369 |
$64K |
| D1351 |
Sealant - per tooth |
2,171 |
627 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,453 |
1,273 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
522 |
521 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
407 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,368 |
1,353 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
223 |
170 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,050 |
2,017 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
425 |
287 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,188 |
1,168 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
132 |
107 |
$13K |
| D0601 |
|
513 |
504 |
$8K |
| D0603 |
|
507 |
494 |
$8K |
| D0602 |
|
254 |
252 |
$4K |
| D9430 |
|
95 |
93 |
$3K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$2K |
| D9310 |
|
13 |
13 |
$617.40 |
| D0999 |
Unspecified diagnostic procedure, by report |
66 |
65 |
$138.00 |
| D0270 |
|
13 |
13 |
$60.00 |