| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,197 |
1,270 |
$263K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,276 |
1,363 |
$259K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,863 |
545 |
$257K |
| D1120 |
Prophylaxis - child |
5,747 |
5,204 |
$216K |
| D0330 |
Panoramic radiographic image |
3,119 |
2,937 |
$190K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,920 |
1,183 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,043 |
7,275 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
6,104 |
5,452 |
$150K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,900 |
549 |
$146K |
| D1110 |
Prophylaxis - adult |
2,696 |
2,490 |
$143K |
| D2740 |
Crown - porcelain/ceramic |
220 |
154 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
3,069 |
2,863 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
6,655 |
5,862 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,028 |
4,423 |
$105K |
| D2950 |
|
735 |
530 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,180 |
2,048 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,300 |
1,161 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,291 |
1,243 |
$50K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
65 |
54 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,557 |
1,314 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
448 |
429 |
$33K |
| D1320 |
|
1,061 |
983 |
$29K |
| D9310 |
|
568 |
531 |
$28K |
| D9630 |
|
631 |
590 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
44 |
$10K |