| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
20,348 |
4,431 |
$1.50M |
| D1351 |
Sealant - per tooth |
8,582 |
2,064 |
$208K |
| D1120 |
Prophylaxis - child |
5,899 |
5,580 |
$191K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,286 |
342 |
$191K |
| D1206 |
Topical application of fluoride varnish |
8,278 |
7,854 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,438 |
611 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,906 |
3,701 |
$119K |
| D0240 |
|
8,888 |
3,250 |
$110K |
| D1110 |
Prophylaxis - adult |
2,223 |
2,126 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,803 |
4,557 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
628 |
$70K |
| D0330 |
Panoramic radiographic image |
1,137 |
1,103 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,085 |
1,870 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,423 |
1,138 |
$47K |
| D9920 |
|
827 |
758 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
526 |
361 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,076 |
1,739 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,385 |
1,114 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
492 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
525 |
284 |
$8K |
| D1510 |
|
41 |
26 |
$7K |
| D1999 |
|
771 |
640 |
$2K |
| D1556 |
|
15 |
13 |
$773.90 |