| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,230 |
2,644 |
$407K |
| D1120 |
Prophylaxis - child |
8,235 |
8,145 |
$360K |
| D1206 |
Topical application of fluoride varnish |
7,431 |
7,346 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,162 |
1,461 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
4,968 |
4,921 |
$219K |
| D0272 |
Bitewings - two radiographic images |
3,623 |
3,599 |
$121K |
| D9920 |
|
1,431 |
1,364 |
$94K |
| D0330 |
Panoramic radiographic image |
578 |
575 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,708 |
1,652 |
$42K |
| D1110 |
Prophylaxis - adult |
782 |
778 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
305 |
231 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,205 |
1,205 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,347 |
1,320 |
$19K |
| D0274 |
Bitewings - four radiographic images |
459 |
453 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
661 |
645 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
226 |
$11K |
| D0603 |
|
1,053 |
1,043 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
36 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
41 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
177 |
$8K |
| D0602 |
|
681 |
674 |
$7K |
| D0240 |
|
186 |
185 |
$5K |
| D9248 |
|
38 |
37 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$2K |
| D0601 |
|
128 |
128 |
$1K |