| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,034 |
3,899 |
$314K |
| D1120 |
Prophylaxis - child |
9,887 |
9,848 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,073 |
1,932 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
9,741 |
9,707 |
$197K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,590 |
2,112 |
$175K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,144 |
2,097 |
$171K |
| D1110 |
Prophylaxis - adult |
4,282 |
4,263 |
$153K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,347 |
575 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,012 |
11,960 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,680 |
4,657 |
$112K |
| D0274 |
Bitewings - four radiographic images |
5,248 |
5,223 |
$102K |
| D0272 |
Bitewings - two radiographic images |
6,970 |
6,937 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,105 |
1,103 |
$74K |
| D0330 |
Panoramic radiographic image |
3,603 |
3,585 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
5,855 |
5,752 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,903 |
4,769 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,711 |
1,707 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
997 |
978 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
305 |
190 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
741 |
658 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
24 |
$4K |
| D0270 |
|
360 |
356 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$789.66 |
| D7111 |
|
70 |
54 |
$522.08 |
| D0350 |
|
57 |
57 |
$459.49 |
| D0602 |
|
4,134 |
4,039 |
$0.00 |
| D0601 |
|
957 |
936 |
$0.00 |
| D0603 |
|
11,445 |
11,243 |
$0.00 |
| D1999 |
|
295 |
226 |
$0.00 |