| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,823 |
2,193 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
6,501 |
6,451 |
$157K |
| D1206 |
Topical application of fluoride varnish |
6,776 |
6,629 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,734 |
2,586 |
$136K |
| D1120 |
Prophylaxis - child |
4,401 |
4,365 |
$132K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,587 |
1,118 |
$116K |
| D1110 |
Prophylaxis - adult |
2,719 |
2,702 |
$113K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
561 |
504 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
989 |
694 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,347 |
2,332 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,833 |
2,816 |
$56K |
| D0330 |
Panoramic radiographic image |
1,017 |
1,010 |
$45K |
| D2140 |
|
669 |
555 |
$38K |
| D2160 |
|
456 |
363 |
$37K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
364 |
284 |
$36K |
| D2335 |
|
288 |
205 |
$28K |
| D0603 |
|
2,222 |
2,221 |
$22K |
| D1310 |
|
4,358 |
4,341 |
$21K |
| D1330 |
|
4,328 |
4,317 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,830 |
1,788 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
766 |
764 |
$16K |
| D2332 |
|
154 |
102 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
809 |
728 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
313 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
313 |
313 |
$7K |
| D0602 |
|
506 |
506 |
$5K |
| D2161 |
|
51 |
40 |
$5K |
| D0601 |
|
460 |
460 |
$5K |
| D1510 |
|
13 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$884.52 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$693.83 |
| D9110 |
|
16 |
16 |
$552.90 |