| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,314 |
1,139 |
$162K |
| D1120 |
Prophylaxis - child |
1,961 |
1,909 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,007 |
1,954 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
373 |
81 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
353 |
345 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
190 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
820 |
786 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,191 |
2,030 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,690 |
2,605 |
$37K |
| D1110 |
Prophylaxis - adult |
771 |
739 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
950 |
903 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,356 |
2,283 |
$26K |
| D0274 |
Bitewings - four radiographic images |
762 |
739 |
$24K |
| D0272 |
Bitewings - two radiographic images |
975 |
955 |
$22K |
| D9248 |
|
93 |
92 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
32 |
$4K |
| D0160 |
|
124 |
124 |
$2K |
| D0350 |
|
135 |
134 |
$1K |
| D1330 |
|
123 |
122 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
30 |
$447.72 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
14 |
$325.32 |
| D0601 |
|
1,009 |
977 |
$24.05 |
| D0602 |
|
1,024 |
1,010 |
$9.05 |
| D0603 |
|
1,368 |
1,315 |
$9.02 |