| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
71,528 |
12,778 |
$1.93M |
| D1206 |
Topical application of fluoride varnish |
46,566 |
45,386 |
$1.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,237 |
3,165 |
$1.14M |
| D1120 |
Prophylaxis - child |
37,328 |
37,106 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
37,197 |
36,997 |
$895K |
| D1110 |
Prophylaxis - adult |
8,012 |
7,948 |
$293K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,358 |
1,945 |
$281K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,920 |
21,554 |
$214K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,006 |
5,832 |
$180K |
| D0274 |
Bitewings - four radiographic images |
8,506 |
8,454 |
$173K |
| D0272 |
Bitewings - two radiographic images |
12,413 |
12,346 |
$173K |
| D0330 |
Panoramic radiographic image |
4,352 |
4,286 |
$162K |
| D1999 |
|
15,876 |
15,521 |
$157K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,938 |
3,908 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
23,097 |
22,727 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,787 |
1,163 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,203 |
4,149 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,361 |
861 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,605 |
2,571 |
$61K |
| D9420 |
|
565 |
565 |
$45K |
| D1354 |
|
2,878 |
723 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
203 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
271 |
151 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
288 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
20 |
20 |
$360.00 |