| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
34,261 |
7,651 |
$906K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,210 |
1,945 |
$837K |
| D1120 |
Prophylaxis - child |
17,813 |
16,984 |
$596K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,536 |
3,604 |
$590K |
| D0120 |
Periodic oral evaluation - established patient |
21,809 |
20,809 |
$589K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,968 |
3,803 |
$533K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,414 |
3,594 |
$467K |
| D0272 |
Bitewings - two radiographic images |
17,608 |
16,719 |
$385K |
| D1110 |
Prophylaxis - adult |
6,347 |
6,083 |
$327K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,110 |
23,017 |
$326K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,868 |
1,406 |
$223K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,289 |
7,756 |
$210K |
| D0274 |
Bitewings - four radiographic images |
4,218 |
4,075 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
11,713 |
10,924 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,771 |
1,022 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,588 |
7,470 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,863 |
1,698 |
$57K |
| D2330 |
|
397 |
252 |
$28K |
| D2934 |
|
141 |
38 |
$18K |
| D9420 |
|
475 |
459 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
693 |
$12K |
| D0350 |
|
489 |
473 |
$5K |
| D0330 |
Panoramic radiographic image |
41 |
40 |
$2K |
| D0170 |
|
197 |
189 |
$2K |
| D2940 |
|
49 |
37 |
$1K |
| D2331 |
|
15 |
12 |
$1K |
| D9986 |
|
359 |
318 |
$0.00 |
| D0601 |
|
1,615 |
1,563 |
$0.00 |
| D0602 |
|
16,761 |
16,097 |
$0.00 |
| D0603 |
|
9,242 |
8,925 |
$0.00 |