| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,867 |
11,806 |
$630K |
| D1120 |
Prophylaxis - child |
16,572 |
16,462 |
$602K |
| D1310 |
|
10,177 |
10,123 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,426 |
2,752 |
$394K |
| D9920 |
|
2,690 |
2,649 |
$338K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,782 |
993 |
$320K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,728 |
17,614 |
$308K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,304 |
4,294 |
$277K |
| D9993 |
|
3,103 |
3,096 |
$197K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,824 |
2,818 |
$175K |
| D0603 |
|
8,102 |
8,049 |
$118K |
| D1351 |
Sealant - per tooth |
4,510 |
1,473 |
$114K |
| D0272 |
Bitewings - two radiographic images |
9,548 |
9,497 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,898 |
997 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,295 |
710 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,640 |
8,874 |
$92K |
| D2330 |
|
1,126 |
517 |
$80K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
813 |
400 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,685 |
1,613 |
$65K |
| D0350 |
|
5,574 |
2,588 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,318 |
5,201 |
$60K |
| D9420 |
|
660 |
396 |
$55K |
| D9248 |
|
1,373 |
1,302 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
729 |
318 |
$34K |
| D0330 |
Panoramic radiographic image |
1,243 |
1,241 |
$33K |
| D0602 |
|
1,725 |
1,719 |
$25K |
| D2932 |
|
179 |
58 |
$17K |
| D9430 |
|
381 |
371 |
$11K |
| D1510 |
|
31 |
24 |
$5K |
| D3230 |
|
39 |
13 |
$4K |
| D0274 |
Bitewings - four radiographic images |
135 |
134 |
$2K |