| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
23,520 |
4,912 |
$559K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,569 |
1,831 |
$353K |
| D1206 |
Topical application of fluoride varnish |
9,935 |
9,445 |
$241K |
| D1120 |
Prophylaxis - child |
8,047 |
7,686 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
11,366 |
10,762 |
$232K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,620 |
1,152 |
$152K |
| D1110 |
Prophylaxis - adult |
3,898 |
3,696 |
$151K |
| D0272 |
Bitewings - two radiographic images |
6,517 |
6,160 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,280 |
3,132 |
$90K |
| D0330 |
Panoramic radiographic image |
1,968 |
1,861 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,045 |
2,648 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
466 |
228 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
407 |
189 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
853 |
794 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
648 |
607 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,783 |
1,580 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
232 |
73 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
490 |
$8K |
| D2335 |
|
44 |
28 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$4K |
| D2332 |
|
38 |
17 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
111 |
105 |
$3K |
| D2160 |
|
26 |
12 |
$2K |
| D0270 |
|
147 |
138 |
$2K |
| D2140 |
|
27 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
20 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
152 |
99 |
$1K |
| D0190 |
|
91 |
91 |
$0.00 |