| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,284 |
1,720 |
$195K |
| D1120 |
Prophylaxis - child |
6,225 |
5,833 |
$192K |
| D1206 |
Topical application of fluoride varnish |
9,164 |
8,564 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,322 |
1,609 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
6,788 |
6,407 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,088 |
2,730 |
$133K |
| D1110 |
Prophylaxis - adult |
2,061 |
1,945 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,250 |
910 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
830 |
587 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,345 |
2,211 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,728 |
3,500 |
$56K |
| D1330 |
|
6,538 |
6,010 |
$52K |
| D1310 |
|
6,526 |
5,986 |
$51K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
318 |
266 |
$36K |
| D1320 |
|
2,477 |
2,299 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,324 |
3,056 |
$27K |
| D0330 |
Panoramic radiographic image |
671 |
627 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,645 |
2,270 |
$22K |
| D0603 |
|
2,060 |
1,963 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
181 |
$16K |
| D9920 |
|
179 |
170 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
687 |
640 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
602 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
138 |
103 |
$7K |
| D1354 |
|
322 |
179 |
$7K |
| D0602 |
|
425 |
412 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$210.04 |