| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
15,768 |
3,533 |
$413K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,682 |
1,010 |
$369K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,043 |
1,860 |
$360K |
| D1120 |
Prophylaxis - child |
8,942 |
8,815 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
10,327 |
10,181 |
$287K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,052 |
2,040 |
$284K |
| D9248 |
|
2,410 |
2,283 |
$259K |
| D1206 |
Topical application of fluoride varnish |
10,739 |
10,573 |
$152K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,774 |
726 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,991 |
5,412 |
$136K |
| D1110 |
Prophylaxis - adult |
2,430 |
2,387 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,842 |
1,063 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,020 |
3,948 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,487 |
872 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
6,646 |
6,400 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,465 |
1,421 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,576 |
1,517 |
$39K |
| D0330 |
Panoramic radiographic image |
591 |
581 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,663 |
1,601 |
$28K |
| D1330 |
|
2,733 |
2,624 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
696 |
671 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
374 |
$5K |
| D2332 |
|
46 |
29 |
$5K |
| D2330 |
|
35 |
26 |
$2K |
| D7111 |
|
43 |
27 |
$493.21 |
| D0603 |
|
13,505 |
13,337 |
$0.00 |