| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,626 |
1,293 |
$119K |
| D1120 |
Prophylaxis - child |
3,553 |
3,528 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,715 |
4,684 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,402 |
4,375 |
$90K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
821 |
174 |
$86K |
| D9920 |
|
656 |
641 |
$81K |
| D1110 |
Prophylaxis - adult |
1,387 |
1,382 |
$51K |
| D1310 |
|
4,978 |
4,946 |
$50K |
| D1330 |
|
4,967 |
4,936 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,748 |
2,737 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
755 |
559 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
842 |
823 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,179 |
1,176 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
188 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,983 |
2,963 |
$22K |
| D0330 |
Panoramic radiographic image |
552 |
552 |
$20K |
| D2140 |
|
314 |
266 |
$14K |
| D0240 |
|
709 |
669 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
608 |
605 |
$12K |
| D1320 |
|
481 |
480 |
$9K |
| D2160 |
|
126 |
100 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
430 |
357 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$850.00 |
| D1999 |
|
40 |
40 |
$0.00 |