| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,187 |
2,163 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,150 |
1,216 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,807 |
1,039 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,373 |
5,145 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,214 |
4,138 |
$100K |
| D1110 |
Prophylaxis - adult |
2,268 |
2,232 |
$97K |
| D0145 |
Oral evaluation for a patient under three years of age |
827 |
811 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,099 |
3,047 |
$85K |
| D1120 |
Prophylaxis - child |
2,952 |
2,911 |
$84K |
| D1206 |
Topical application of fluoride varnish |
5,122 |
5,063 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,745 |
5,627 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,271 |
1,240 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
314 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
720 |
663 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
91 |
68 |
$10K |
| D0272 |
Bitewings - two radiographic images |
467 |
456 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
93 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
213 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
14 |
$840.46 |
| D7111 |
|
17 |
12 |
$126.22 |
| D0603 |
|
4,620 |
4,573 |
$90.33 |
| D0602 |
|
685 |
682 |
$9.00 |
| D0601 |
|
901 |
866 |
$0.02 |