| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
18,555 |
4,303 |
$477K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,566 |
2,151 |
$428K |
| D0120 |
Periodic oral evaluation - established patient |
12,811 |
12,472 |
$347K |
| D1110 |
Prophylaxis - adult |
5,984 |
5,826 |
$304K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,981 |
1,947 |
$271K |
| D1120 |
Prophylaxis - child |
7,777 |
7,576 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,496 |
1,698 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,781 |
13,426 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,371 |
400 |
$189K |
| D0274 |
Bitewings - four radiographic images |
6,366 |
6,173 |
$188K |
| D0220 |
Intraoral - periapical first radiographic image |
13,239 |
12,860 |
$155K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,620 |
12,312 |
$144K |
| D0272 |
Bitewings - two radiographic images |
6,996 |
6,818 |
$143K |
| D0330 |
Panoramic radiographic image |
2,743 |
2,645 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,320 |
2,152 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
728 |
727 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
864 |
826 |
$28K |
| D9248 |
|
244 |
234 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
64 |
$12K |
| D2335 |
|
40 |
24 |
$5K |
| D2330 |
|
37 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
65 |
$1K |
| D0603 |
|
15,674 |
15,246 |
$0.00 |
| D0602 |
|
291 |
280 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |