| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,389 |
698 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,562 |
1,548 |
$72K |
| D1120 |
Prophylaxis - child |
1,663 |
1,657 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,275 |
2,260 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,942 |
1,931 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
621 |
461 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
324 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
434 |
345 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
481 |
365 |
$25K |
| D1110 |
Prophylaxis - adult |
633 |
627 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,124 |
1,122 |
$20K |
| D0274 |
Bitewings - four radiographic images |
632 |
625 |
$19K |
| D2140 |
|
229 |
189 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
94 |
78 |
$8K |
| D1330 |
|
1,654 |
1,647 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
875 |
872 |
$8K |
| D0602 |
|
628 |
623 |
$6K |
| D0603 |
|
594 |
593 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
676 |
660 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
252 |
252 |
$5K |
| D0601 |
|
316 |
316 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
115 |
$3K |
| D9920 |
|
13 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
36 |
$1K |