| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,735 |
3,329 |
$307K |
| D1120 |
Prophylaxis - child |
8,504 |
8,403 |
$297K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,080 |
1,009 |
$291K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,971 |
1,958 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
8,163 |
8,061 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,267 |
1,545 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,441 |
10,310 |
$147K |
| D0272 |
Bitewings - two radiographic images |
6,622 |
6,511 |
$141K |
| D9248 |
|
1,149 |
1,116 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,528 |
981 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
8,320 |
8,136 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,391 |
4,052 |
$82K |
| D1110 |
Prophylaxis - adult |
1,509 |
1,481 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,401 |
7,049 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,204 |
1,178 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
972 |
$33K |
| D0330 |
Panoramic radiographic image |
913 |
900 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
296 |
142 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
77 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
176 |
$3K |
| D0270 |
|
503 |
495 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D2331 |
|
19 |
14 |
$1K |
| D9420 |
|
13 |
12 |
$432.93 |
| D0603 |
|
12,144 |
12,016 |
$0.00 |
| D0191 |
|
516 |
496 |
$0.00 |