| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,908 |
449 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
472 |
182 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
791 |
750 |
$24K |
| D1120 |
Prophylaxis - child |
720 |
697 |
$23K |
| D0330 |
Panoramic radiographic image |
673 |
628 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
113 |
111 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
197 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,011 |
977 |
$13K |
| D0272 |
Bitewings - two radiographic images |
732 |
706 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
403 |
395 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,394 |
1,242 |
$9K |
| D1110 |
Prophylaxis - adult |
187 |
181 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
406 |
342 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,718 |
1,149 |
$8K |
| D0274 |
Bitewings - four radiographic images |
376 |
354 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
42 |
$7K |
| D0350 |
|
600 |
556 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
12 |
$2K |
| D9248 |
|
42 |
32 |
$2K |
| D1330 |
|
788 |
756 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
26 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
31 |
$542.74 |
| D9920 |
|
40 |
32 |
$139.66 |
| D0601 |
|
100 |
98 |
$0.00 |
| D0603 |
|
1,248 |
1,197 |
$0.00 |