| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
29,747 |
5,749 |
$756K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,602 |
3,585 |
$741K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,761 |
4,481 |
$583K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,973 |
1,189 |
$558K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,911 |
3,488 |
$519K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,620 |
11,780 |
$450K |
| D1120 |
Prophylaxis - child |
8,693 |
8,587 |
$303K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,125 |
6,804 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,449 |
5,357 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,427 |
6,364 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,405 |
11,250 |
$160K |
| D0220 |
Intraoral - periapical first radiographic image |
12,722 |
12,482 |
$152K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,822 |
597 |
$147K |
| D0274 |
Bitewings - four radiographic images |
3,885 |
3,824 |
$129K |
| D1110 |
Prophylaxis - adult |
2,407 |
2,382 |
$123K |
| D0350 |
|
2,783 |
2,718 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,876 |
1,853 |
$42K |
| D9248 |
|
223 |
221 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
191 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
385 |
379 |
$7K |
| D2330 |
|
89 |
55 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
36 |
$5K |
| D2332 |
|
20 |
13 |
$2K |
| D7111 |
|
172 |
122 |
$2K |
| D1330 |
|
308 |
297 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$707.30 |
| D0330 |
Panoramic radiographic image |
18 |
16 |
$224.19 |
| D0603 |
|
17,218 |
16,821 |
$0.04 |
| D9986 |
|
16 |
16 |
$0.00 |