| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
22,876 |
4,169 |
$603K |
| D0120 |
Periodic oral evaluation - established patient |
14,568 |
14,228 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,916 |
2,038 |
$350K |
| D1120 |
Prophylaxis - child |
10,031 |
9,795 |
$348K |
| D1110 |
Prophylaxis - adult |
6,337 |
6,191 |
$326K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,296 |
2,242 |
$309K |
| D0274 |
Bitewings - four radiographic images |
8,591 |
8,383 |
$244K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,753 |
16,376 |
$235K |
| D0220 |
Intraoral - periapical first radiographic image |
15,193 |
14,634 |
$176K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,676 |
14,356 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,999 |
1,221 |
$143K |
| D0272 |
Bitewings - two radiographic images |
6,642 |
6,497 |
$139K |
| D7240 |
Removal of impacted tooth - completely bony |
329 |
98 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,047 |
1,964 |
$66K |
| D0330 |
Panoramic radiographic image |
2,554 |
2,488 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
861 |
860 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,398 |
1,331 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
856 |
793 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
110 |
$14K |
| D9239 |
|
173 |
168 |
$9K |
| D9243 |
|
173 |
168 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
53 |
$3K |
| D0602 |
|
2,742 |
2,710 |
$0.00 |
| D0603 |
|
3,459 |
3,411 |
$0.00 |
| D0601 |
|
12,887 |
12,599 |
$0.00 |