| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,766 |
2,386 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,119 |
1,428 |
$215K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,560 |
1,511 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
6,308 |
6,190 |
$132K |
| D1120 |
Prophylaxis - child |
4,839 |
4,749 |
$123K |
| D1110 |
Prophylaxis - adult |
2,611 |
2,559 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,552 |
4,434 |
$84K |
| D1206 |
Topical application of fluoride varnish |
7,538 |
7,394 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
8,275 |
8,011 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,183 |
7,586 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,474 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,115 |
1,906 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,263 |
2,206 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
650 |
374 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
348 |
347 |
$21K |
| D0330 |
Panoramic radiographic image |
1,113 |
1,087 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
72 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
113 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$244.14 |
| D0603 |
|
8,474 |
8,307 |
$16.02 |
| D0602 |
|
847 |
824 |
$0.26 |
| D0601 |
|
122 |
120 |
$0.07 |