| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,753 |
1,659 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,473 |
1,057 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,689 |
1,133 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,272 |
4,215 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
5,165 |
5,106 |
$117K |
| D1206 |
Topical application of fluoride varnish |
5,950 |
5,864 |
$108K |
| D1120 |
Prophylaxis - child |
3,313 |
3,273 |
$105K |
| D1110 |
Prophylaxis - adult |
2,287 |
2,260 |
$102K |
| D0330 |
Panoramic radiographic image |
549 |
532 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
940 |
831 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,079 |
1,976 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,793 |
1,505 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
56 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
61 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
189 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$2K |
| D1999 |
|
2,074 |
1,744 |
$0.00 |