| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,549 |
2,368 |
$451K |
| D1120 |
Prophylaxis - child |
11,360 |
10,364 |
$449K |
| D0120 |
Periodic oral evaluation - established patient |
13,483 |
12,326 |
$355K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,508 |
12,352 |
$296K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,819 |
1,522 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,206 |
1,199 |
$240K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,435 |
202 |
$208K |
| D0272 |
Bitewings - two radiographic images |
6,679 |
6,090 |
$177K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,105 |
3,754 |
$170K |
| D1110 |
Prophylaxis - adult |
2,831 |
2,622 |
$156K |
| D0330 |
Panoramic radiographic image |
2,203 |
1,997 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
2,631 |
2,331 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
923 |
511 |
$76K |
| D9310 |
|
514 |
499 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,495 |
1,370 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
226 |
62 |
$22K |
| D1354 |
|
259 |
93 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
373 |
$14K |
| D2330 |
|
116 |
60 |
$10K |
| D1206 |
Topical application of fluoride varnish |
341 |
337 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
175 |
174 |
$5K |
| D9420 |
|
126 |
118 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
351 |
244 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
86 |
49 |
$0.00 |
| D1999 |
|
5,812 |
5,198 |
$0.00 |