| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
81,698 |
15,854 |
$2.10M |
| D1206 |
Topical application of fluoride varnish |
70,989 |
68,888 |
$1.72M |
| D1120 |
Prophylaxis - child |
57,282 |
56,923 |
$1.60M |
| D0120 |
Periodic oral evaluation - established patient |
55,425 |
55,058 |
$1.31M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,676 |
2,111 |
$802K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,456 |
4,851 |
$607K |
| D1110 |
Prophylaxis - adult |
12,556 |
12,454 |
$449K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67,148 |
35,531 |
$350K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,502 |
10,919 |
$337K |
| D1999 |
|
31,001 |
30,348 |
$305K |
| D0272 |
Bitewings - two radiographic images |
20,090 |
19,958 |
$280K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,253 |
3,145 |
$269K |
| D0274 |
Bitewings - four radiographic images |
12,725 |
12,633 |
$261K |
| D0220 |
Intraoral - periapical first radiographic image |
39,026 |
38,499 |
$256K |
| D0145 |
Oral evaluation for a patient under three years of age |
6,180 |
6,142 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,127 |
8,079 |
$194K |
| D0330 |
Panoramic radiographic image |
3,198 |
3,176 |
$117K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,213 |
750 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,919 |
2,893 |
$68K |
| D9420 |
|
738 |
734 |
$60K |
| D7111 |
|
593 |
400 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
124 |
64 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
352 |
347 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
38 |
$5K |
| D0240 |
|
563 |
210 |
$4K |
| D0270 |
|
282 |
281 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$2K |
| D1354 |
|
58 |
27 |
$580.00 |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$0.00 |
| D0251 |
|
14 |
14 |
$0.00 |
| D0350 |
|
12 |
12 |
$0.00 |