| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
19,324 |
4,164 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,882 |
2,483 |
$278K |
| D1120 |
Prophylaxis - child |
8,046 |
7,885 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
8,624 |
8,459 |
$156K |
| D1110 |
Prophylaxis - adult |
4,726 |
4,639 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,275 |
1,975 |
$149K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,756 |
1,739 |
$125K |
| D1206 |
Topical application of fluoride varnish |
11,573 |
11,339 |
$104K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
994 |
399 |
$99K |
| D0274 |
Bitewings - four radiographic images |
5,716 |
5,603 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,406 |
4,293 |
$97K |
| D0272 |
Bitewings - two radiographic images |
5,880 |
5,767 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,024 |
1,013 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,114 |
2,887 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
7,122 |
6,936 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,546 |
5,904 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
514 |
320 |
$31K |
| D0330 |
Panoramic radiographic image |
3,177 |
3,120 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
313 |
189 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
363 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
955 |
952 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
13 |
$2K |
| D0350 |
|
65 |
65 |
$466.85 |
| D0270 |
|
146 |
145 |
$431.90 |
| D2950 |
|
17 |
12 |
$365.50 |
| D0603 |
|
10,878 |
10,671 |
$9.07 |
| D0601 |
|
812 |
794 |
$0.00 |
| D0602 |
|
3,061 |
2,990 |
$0.00 |
| D1999 |
|
151 |
136 |
$0.00 |