| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,509 |
1,628 |
$244K |
| D1120 |
Prophylaxis - child |
5,381 |
5,297 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
6,062 |
5,969 |
$174K |
| D1206 |
Topical application of fluoride varnish |
6,918 |
6,808 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,073 |
597 |
$127K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
613 |
342 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
915 |
511 |
$92K |
| D1110 |
Prophylaxis - adult |
1,394 |
1,370 |
$80K |
| D0330 |
Panoramic radiographic image |
1,749 |
1,707 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
775 |
515 |
$71K |
| D0272 |
Bitewings - two radiographic images |
4,485 |
4,416 |
$66K |
| D9248 |
|
254 |
245 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
792 |
771 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,446 |
1,420 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,407 |
1,367 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
436 |
412 |
$18K |
| D1330 |
|
2,213 |
2,167 |
$13K |
| D3120 |
|
240 |
150 |
$8K |
| D2940 |
|
25 |
16 |
$1K |
| D4355 |
|
12 |
12 |
$1K |