| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
47,488 |
7,252 |
$1.97M |
| D1120 |
Prophylaxis - child |
31,504 |
29,661 |
$1.82M |
| D0120 |
Periodic oral evaluation - established patient |
32,267 |
30,555 |
$1.42M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,993 |
4,223 |
$1.17M |
| D1206 |
Topical application of fluoride varnish |
34,823 |
32,787 |
$898K |
| D1110 |
Prophylaxis - adult |
8,109 |
7,682 |
$649K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,961 |
870 |
$623K |
| D0330 |
Panoramic radiographic image |
5,893 |
5,571 |
$530K |
| D0272 |
Bitewings - two radiographic images |
14,500 |
13,599 |
$529K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,680 |
2,214 |
$423K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,551 |
7,495 |
$417K |
| D0274 |
Bitewings - four radiographic images |
5,616 |
5,333 |
$307K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,100 |
4,773 |
$305K |
| D7140 |
Extraction, erupted tooth or exposed root |
804 |
331 |
$94K |
| D0240 |
|
1,798 |
1,137 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
1,728 |
1,501 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,882 |
590 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
438 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
69 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
124 |
51 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
238 |
231 |
$12K |
| D2331 |
|
32 |
13 |
$4K |
| D2330 |
|
15 |
13 |
$2K |