| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
36,006 |
8,883 |
$993K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,867 |
3,024 |
$614K |
| D1120 |
Prophylaxis - child |
21,152 |
20,422 |
$559K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,002 |
8,720 |
$386K |
| D0120 |
Periodic oral evaluation - established patient |
14,416 |
13,953 |
$362K |
| D0330 |
Panoramic radiographic image |
5,840 |
5,680 |
$332K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,625 |
16,981 |
$281K |
| D0272 |
Bitewings - two radiographic images |
12,341 |
11,931 |
$216K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,720 |
10,259 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,262 |
1,520 |
$176K |
| D0220 |
Intraoral - periapical first radiographic image |
10,742 |
10,398 |
$157K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,274 |
3,151 |
$143K |
| D1206 |
Topical application of fluoride varnish |
5,513 |
5,428 |
$90K |
| D1110 |
Prophylaxis - adult |
2,232 |
2,132 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
341 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,349 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
43 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
71 |
$3K |