| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
13,602 |
3,144 |
$354K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,147 |
2,125 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,043 |
1,930 |
$284K |
| D1120 |
Prophylaxis - child |
6,791 |
6,738 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
8,034 |
7,981 |
$223K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,299 |
9,735 |
$159K |
| D0274 |
Bitewings - four radiographic images |
4,968 |
4,928 |
$158K |
| D1110 |
Prophylaxis - adult |
2,891 |
2,869 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,943 |
9,862 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
10,037 |
9,938 |
$117K |
| D0272 |
Bitewings - two radiographic images |
4,469 |
4,434 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
844 |
600 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,732 |
2,610 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,263 |
$43K |
| D0330 |
Panoramic radiographic image |
980 |
959 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
210 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
103 |
60 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
132 |
$7K |
| D2394 |
|
13 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$918.08 |
| D7111 |
|
21 |
16 |
$229.40 |
| D1330 |
|
26 |
22 |
$171.50 |
| D0603 |
|
12,423 |
12,318 |
$0.00 |
| D0602 |
|
35 |
35 |
$0.00 |