| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
18,475 |
2,847 |
$448K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,183 |
3,076 |
$407K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,666 |
1,690 |
$338K |
| D1120 |
Prophylaxis - child |
6,289 |
6,126 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
7,672 |
7,455 |
$208K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,708 |
6,903 |
$176K |
| D1110 |
Prophylaxis - adult |
2,747 |
2,663 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,896 |
1,092 |
$135K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
897 |
247 |
$115K |
| D0274 |
Bitewings - four radiographic images |
2,904 |
2,827 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,715 |
7,367 |
$87K |
| D1206 |
Topical application of fluoride varnish |
6,002 |
5,840 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
858 |
851 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,585 |
1,537 |
$51K |
| D0330 |
Panoramic radiographic image |
1,759 |
1,709 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,884 |
2,811 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,805 |
2,737 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,387 |
1,331 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
112 |
$15K |
| D9248 |
|
104 |
101 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
423 |
405 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
29 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$512.48 |
| D0603 |
|
12,487 |
12,032 |
$0.00 |