| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,596 |
3,938 |
$282K |
| D1120 |
Prophylaxis - child |
8,768 |
8,526 |
$263K |
| D0120 |
Periodic oral evaluation - established patient |
11,066 |
10,774 |
$234K |
| D1206 |
Topical application of fluoride varnish |
12,521 |
12,161 |
$214K |
| D1110 |
Prophylaxis - adult |
3,598 |
3,476 |
$147K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,225 |
609 |
$145K |
| D0272 |
Bitewings - two radiographic images |
6,721 |
6,544 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,827 |
1,291 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,692 |
3,572 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,225 |
869 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,951 |
2,652 |
$58K |
| D0330 |
Panoramic radiographic image |
1,231 |
1,196 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
811 |
$25K |
| D2140 |
|
422 |
326 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
229 |
176 |
$15K |
| D0240 |
|
593 |
543 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
256 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
425 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
25 |
$3K |
| D1330 |
|
125 |
125 |
$0.00 |
| D1310 |
|
125 |
125 |
$0.00 |
| D1320 |
|
22 |
22 |
$0.00 |
| D0603 |
|
126 |
126 |
$0.00 |