| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,264 |
1,219 |
$159K |
| D0145 |
Oral evaluation for a patient under three years of age |
778 |
775 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,133 |
362 |
$105K |
| D1120 |
Prophylaxis - child |
2,693 |
2,633 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,057 |
2,962 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,056 |
3,479 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,570 |
3,480 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
339 |
56 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,390 |
1,332 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,754 |
3,603 |
$43K |
| D1110 |
Prophylaxis - adult |
847 |
812 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,493 |
1,466 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
314 |
306 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
628 |
606 |
$18K |
| D9248 |
|
145 |
141 |
$17K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
65 |
15 |
$5K |
| D2934 |
|
27 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
30 |
$3K |
| D0160 |
|
178 |
176 |
$3K |
| D0350 |
|
151 |
148 |
$2K |
| D1330 |
|
151 |
149 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
58 |
$825.76 |
| D0601 |
|
2,737 |
2,667 |
$24.01 |
| D0603 |
|
839 |
822 |
$9.01 |
| D0602 |
|
868 |
848 |
$9.00 |