| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,785 |
2,779 |
$449K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,335 |
1,770 |
$377K |
| D2740 |
Crown - porcelain/ceramic |
448 |
295 |
$266K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,900 |
496 |
$264K |
| D0330 |
Panoramic radiographic image |
4,032 |
3,698 |
$251K |
| D1110 |
Prophylaxis - adult |
4,192 |
3,755 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,332 |
1,276 |
$213K |
| D1120 |
Prophylaxis - child |
5,386 |
4,740 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,795 |
7,722 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,147 |
6,249 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,028 |
499 |
$166K |
| D1354 |
|
2,972 |
611 |
$165K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,240 |
2,650 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,403 |
5,475 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
8,032 |
7,039 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
3,002 |
2,847 |
$111K |
| D2950 |
|
640 |
428 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,142 |
1,077 |
$81K |
| D9310 |
|
1,246 |
1,159 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,805 |
1,652 |
$63K |
| D1320 |
|
2,091 |
1,875 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
252 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,365 |
1,325 |
$52K |
| D4341 |
|
293 |
132 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,541 |
1,301 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
26 |
$22K |
| D9630 |
|
1,264 |
1,220 |
$21K |
| D5110 |
|
13 |
13 |
$8K |
| D1353 |
|
277 |
67 |
$4K |
| D2332 |
|
15 |
12 |
$2K |
| D0350 |
|
52 |
52 |
$1K |
| D0180 |
|
17 |
14 |
$850.00 |
| D0340 |
|
12 |
12 |
$792.84 |