| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
62,688 |
17,963 |
$1.64M |
| D1120 |
Prophylaxis - child |
28,434 |
27,768 |
$926K |
| D0120 |
Periodic oral evaluation - established patient |
38,165 |
37,332 |
$881K |
| D1206 |
Topical application of fluoride varnish |
41,789 |
40,853 |
$779K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,213 |
2,422 |
$657K |
| D1110 |
Prophylaxis - adult |
12,872 |
12,612 |
$582K |
| D0272 |
Bitewings - two radiographic images |
21,494 |
20,995 |
$467K |
| D0274 |
Bitewings - four radiographic images |
13,290 |
13,004 |
$419K |
| D2140 |
|
7,489 |
5,152 |
$409K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,969 |
3,070 |
$398K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,649 |
12,471 |
$387K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,400 |
3,230 |
$288K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,216 |
2,083 |
$274K |
| D0330 |
Panoramic radiographic image |
7,164 |
7,018 |
$265K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,887 |
1,204 |
$175K |
| D0240 |
|
6,229 |
5,919 |
$114K |
| D7240 |
Removal of impacted tooth - completely bony |
588 |
183 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,849 |
2,766 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
2,991 |
2,844 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
747 |
713 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
89 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
393 |
363 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
941 |
482 |
$11K |
| D2330 |
|
59 |
40 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
199 |
199 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$1K |
| D0251 |
|
53 |
52 |
$1K |
| D1330 |
|
108 |
104 |
$0.00 |
| D0603 |
|
110 |
107 |
$0.00 |
| D1310 |
|
108 |
104 |
$0.00 |
| D1320 |
|
18 |
18 |
$0.00 |
| D1999 |
|
9,269 |
8,687 |
$0.00 |
| D0350 |
|
73 |
73 |
$0.00 |