| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
32,025 |
5,408 |
$828K |
| D1120 |
Prophylaxis - child |
8,266 |
7,912 |
$271K |
| D1206 |
Topical application of fluoride varnish |
13,217 |
12,606 |
$246K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,885 |
875 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
7,664 |
7,445 |
$179K |
| D1110 |
Prophylaxis - adult |
2,989 |
2,821 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,658 |
936 |
$125K |
| D0272 |
Bitewings - two radiographic images |
6,699 |
6,392 |
$125K |
| D0330 |
Panoramic radiographic image |
2,645 |
2,422 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,877 |
3,513 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,485 |
1,012 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,227 |
4,801 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,884 |
2,489 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,930 |
2,771 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
6,338 |
5,973 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,055 |
614 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,360 |
1,324 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
145 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
477 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
205 |
107 |
$12K |
| D9920 |
|
164 |
146 |
$5K |
| D2160 |
|
42 |
24 |
$3K |
| D9995 |
|
66 |
62 |
$282.21 |
| D1330 |
|
13,601 |
12,949 |
$32.08 |
| D0350 |
|
4,163 |
1,833 |
$0.00 |
| D1999 |
|
1,304 |
1,129 |
$0.00 |
| D0601 |
|
1,177 |
1,142 |
$0.00 |
| D0603 |
|
10,265 |
9,917 |
$0.00 |
| D0602 |
|
575 |
559 |
$0.00 |