| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,509 |
24,408 |
$1.17M |
| D0120 |
Periodic oral evaluation - established patient |
14,570 |
14,511 |
$989K |
| D1310 |
|
11,425 |
11,365 |
$523K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,113 |
6,096 |
$420K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100,820 |
15,635 |
$401K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,683 |
15,576 |
$326K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,372 |
4,352 |
$310K |
| D1351 |
Sealant - per tooth |
6,530 |
1,857 |
$207K |
| D1206 |
Topical application of fluoride varnish |
8,797 |
8,796 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,651 |
1,696 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,918 |
3,495 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,475 |
1,482 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
10,389 |
10,296 |
$121K |
| D0603 |
|
6,583 |
6,550 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,716 |
1,169 |
$96K |
| D0350 |
|
7,319 |
3,904 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,556 |
3,540 |
$75K |
| D0601 |
|
4,009 |
3,988 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
427 |
317 |
$51K |
| D9430 |
|
1,398 |
1,365 |
$44K |
| D1354 |
|
2,350 |
756 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,186 |
2,182 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
233 |
181 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
475 |
473 |
$22K |
| D0602 |
|
811 |
806 |
$12K |
| D9993 |
|
12 |
12 |
$0.00 |