| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,436 |
1,896 |
$465K |
| D1120 |
Prophylaxis - child |
6,923 |
6,558 |
$405K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,786 |
772 |
$276K |
| D0120 |
Periodic oral evaluation - established patient |
5,567 |
5,272 |
$241K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
922 |
255 |
$162K |
| D0272 |
Bitewings - two radiographic images |
4,257 |
4,034 |
$158K |
| D0330 |
Panoramic radiographic image |
1,475 |
1,391 |
$133K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,051 |
531 |
$128K |
| D1206 |
Topical application of fluoride varnish |
4,672 |
4,411 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
989 |
511 |
$120K |
| D9248 |
|
620 |
583 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,258 |
1,185 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,869 |
2,708 |
$75K |
| D1110 |
Prophylaxis - adult |
860 |
795 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
2,052 |
1,921 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
879 |
794 |
$45K |
| D0274 |
Bitewings - four radiographic images |
797 |
742 |
$43K |
| D9920 |
|
715 |
693 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
615 |
566 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,048 |
988 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
412 |
391 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
206 |
78 |
$24K |
| D2934 |
|
53 |
12 |
$10K |
| D9420 |
|
47 |
40 |
$4K |
| D1999 |
|
491 |
452 |
$0.00 |