| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,656 |
402 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,004 |
1,996 |
$45K |
| D1120 |
Prophylaxis - child |
1,526 |
1,523 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,816 |
1,808 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,689 |
1,686 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
765 |
757 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
331 |
$28K |
| D1110 |
Prophylaxis - adult |
705 |
704 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
316 |
247 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
163 |
$15K |
| D0603 |
|
1,448 |
1,447 |
$14K |
| D0330 |
Panoramic radiographic image |
283 |
281 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
110 |
91 |
$11K |
| D1330 |
|
1,528 |
1,527 |
$8K |
| D1206 |
Topical application of fluoride varnish |
327 |
327 |
$7K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
396 |
392 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
135 |
135 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
298 |
287 |
$3K |
| D0240 |
|
101 |
81 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$764.00 |
| D1354 |
|
41 |
31 |
$635.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$243.00 |