| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
20,551 |
4,245 |
$553K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,563 |
3,531 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,456 |
2,114 |
$434K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,420 |
1,877 |
$259K |
| D1120 |
Prophylaxis - child |
6,979 |
6,912 |
$250K |
| D0210 |
Intraoral - complete series of radiographic images |
3,169 |
3,132 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,479 |
6,042 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,373 |
4,312 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,144 |
5,124 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,193 |
9,114 |
$132K |
| D1110 |
Prophylaxis - adult |
1,956 |
1,944 |
$105K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
718 |
148 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,806 |
3,556 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
6,518 |
6,455 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,227 |
2,218 |
$52K |
| D0274 |
Bitewings - four radiographic images |
977 |
976 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
398 |
81 |
$33K |
| D2934 |
|
55 |
12 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
280 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
28 |
$5K |
| D2331 |
|
33 |
27 |
$3K |
| D7111 |
|
244 |
176 |
$3K |
| D2330 |
|
26 |
16 |
$2K |
| D0603 |
|
13,705 |
13,574 |
$0.00 |