| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
13,970 |
2,637 |
$492K |
| D1120 |
Prophylaxis - child |
10,396 |
10,223 |
$467K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,307 |
2,041 |
$466K |
| D1206 |
Topical application of fluoride varnish |
14,239 |
14,000 |
$365K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,056 |
1,278 |
$359K |
| D0120 |
Periodic oral evaluation - established patient |
10,951 |
10,769 |
$340K |
| D1110 |
Prophylaxis - adult |
4,031 |
3,972 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,031 |
2,987 |
$166K |
| D0330 |
Panoramic radiographic image |
3,122 |
3,073 |
$150K |
| D0274 |
Bitewings - four radiographic images |
4,861 |
4,793 |
$126K |
| D0272 |
Bitewings - two radiographic images |
7,080 |
6,958 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
619 |
399 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,606 |
3,249 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
4,558 |
4,430 |
$50K |
| D0350 |
|
924 |
918 |
$49K |
| D1330 |
|
7,509 |
7,369 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
249 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,808 |
3,733 |
$27K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
327 |
264 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
475 |
460 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
82 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
169 |
$8K |
| D3120 |
|
163 |
135 |
$6K |
| D2335 |
|
26 |
17 |
$4K |
| D0240 |
|
31 |
25 |
$997.35 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0602 |
|
485 |
482 |
$0.00 |
| D0603 |
|
418 |
415 |
$0.00 |