| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,398 |
1,456 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,661 |
1,289 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,187 |
1,105 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,984 |
2,518 |
$143K |
| D1120 |
Prophylaxis - child |
4,275 |
3,997 |
$121K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,004 |
676 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
5,439 |
5,038 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,809 |
4,473 |
$92K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,017 |
647 |
$74K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,804 |
$73K |
| D1330 |
|
5,845 |
5,410 |
$53K |
| D1310 |
|
5,850 |
5,415 |
$52K |
| D9920 |
|
748 |
662 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,193 |
1,825 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
600 |
408 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,097 |
$33K |
| D0330 |
Panoramic radiographic image |
813 |
776 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,951 |
1,834 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
662 |
637 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
303 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
759 |
$17K |
| D0603 |
|
1,485 |
1,465 |
$15K |
| D0601 |
|
636 |
613 |
$6K |
| D0240 |
|
431 |
412 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
329 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D9110 |
|
40 |
39 |
$1K |
| D2330 |
|
15 |
12 |
$798.05 |