| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
8,611 |
1,781 |
$210K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,846 |
733 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,302 |
8,060 |
$191K |
| D1120 |
Prophylaxis - child |
6,209 |
6,058 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
7,888 |
7,718 |
$171K |
| D0274 |
Bitewings - four radiographic images |
5,715 |
5,584 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,280 |
8,082 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,894 |
1,113 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,379 |
779 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,528 |
969 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
8,608 |
8,378 |
$105K |
| D1110 |
Prophylaxis - adult |
2,337 |
2,291 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,330 |
2,898 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,550 |
1,498 |
$45K |
| D0330 |
Panoramic radiographic image |
1,006 |
979 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,362 |
1,338 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
305 |
183 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
325 |
318 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
65 |
$6K |
| D0272 |
Bitewings - two radiographic images |
292 |
283 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
164 |
158 |
$5K |
| D2332 |
|
40 |
28 |
$3K |
| D0273 |
|
15 |
13 |
$367.82 |
| D0270 |
|
15 |
13 |
$184.44 |