| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,985 |
2,802 |
$272K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,382 |
1,318 |
$235K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,394 |
1,384 |
$195K |
| D1120 |
Prophylaxis - child |
4,996 |
4,918 |
$178K |
| D1110 |
Prophylaxis - adult |
3,296 |
3,258 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,040 |
5,952 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,839 |
4,771 |
$150K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,304 |
8,183 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,933 |
7,825 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
8,108 |
7,971 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
933 |
529 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,748 |
2,703 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,618 |
1,592 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,007 |
950 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
238 |
$14K |
| D9248 |
|
126 |
117 |
$13K |
| D0330 |
Panoramic radiographic image |
659 |
649 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64 |
28 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D1354 |
|
66 |
25 |
$884.50 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$863.88 |
| D0603 |
|
9,432 |
9,313 |
$0.00 |
| D0602 |
|
20 |
20 |
$0.00 |