| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,637 |
1,797 |
$229K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,982 |
2,915 |
$135K |
| D1120 |
Prophylaxis - child |
4,015 |
4,001 |
$123K |
| D1206 |
Topical application of fluoride varnish |
5,660 |
5,626 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,641 |
4,614 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,297 |
956 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
940 |
689 |
$63K |
| D1110 |
Prophylaxis - adult |
1,562 |
1,553 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,068 |
804 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
934 |
677 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,651 |
1,640 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,643 |
2,630 |
$45K |
| D1330 |
|
3,657 |
3,640 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
298 |
252 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,142 |
2,125 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,702 |
1,670 |
$15K |
| D0602 |
|
1,122 |
1,117 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
519 |
519 |
$11K |
| D0603 |
|
1,057 |
1,047 |
$11K |
| D1310 |
|
1,036 |
1,036 |
$11K |
| D2140 |
|
203 |
178 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
439 |
$9K |
| D0330 |
Panoramic radiographic image |
227 |
227 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
98 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
87 |
71 |
$7K |
| D1320 |
|
470 |
460 |
$5K |
| D9920 |
|
32 |
31 |
$4K |
| D2160 |
|
48 |
47 |
$3K |
| D0601 |
|
318 |
316 |
$3K |
| D1354 |
|
30 |
12 |
$875.00 |
| D9110 |
|
13 |
13 |
$419.43 |