| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
31,286 |
7,047 |
$843K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,931 |
2,134 |
$701K |
| D9248 |
|
3,193 |
3,131 |
$365K |
| D0120 |
Periodic oral evaluation - established patient |
12,477 |
12,333 |
$352K |
| D1120 |
Prophylaxis - child |
9,321 |
9,224 |
$333K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,166 |
2,091 |
$283K |
| D0272 |
Bitewings - two radiographic images |
13,659 |
13,493 |
$279K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,821 |
1,799 |
$253K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,326 |
1,533 |
$214K |
| D1110 |
Prophylaxis - adult |
3,598 |
3,563 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,562 |
11,442 |
$166K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,657 |
875 |
$132K |
| D0330 |
Panoramic radiographic image |
3,232 |
3,194 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,062 |
1,062 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,837 |
1,799 |
$62K |
| D2330 |
|
538 |
343 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
638 |
396 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,844 |
2,798 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,065 |
1,044 |
$27K |
| D1206 |
Topical application of fluoride varnish |
2,027 |
1,988 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,723 |
1,535 |
$18K |
| D2331 |
|
65 |
49 |
$6K |
| D1354 |
|
546 |
225 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
214 |
$3K |
| D0350 |
|
517 |
304 |
$3K |
| D0603 |
|
3,242 |
3,192 |
$0.00 |
| D0601 |
|
1,456 |
1,446 |
$0.00 |
| D0602 |
|
11,347 |
11,232 |
$0.00 |