| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,280 |
2,368 |
$134K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,180 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
920 |
900 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,929 |
3,859 |
$69K |
| D1120 |
Prophylaxis - child |
2,956 |
2,906 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,102 |
733 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,689 |
2,613 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,293 |
5,168 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
623 |
421 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,331 |
2,297 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,248 |
1,196 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,730 |
3,592 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,478 |
3,292 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
321 |
321 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
79 |
29 |
$13K |
| D0330 |
Panoramic radiographic image |
1,296 |
1,261 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
117 |
63 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
373 |
347 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
118 |
117 |
$2K |
| D7111 |
|
13 |
13 |
$97.54 |
| D0603 |
|
6,085 |
5,934 |
$0.00 |
| D0602 |
|
73 |
69 |
$0.00 |
| D0601 |
|
34 |
34 |
$0.00 |
| D1999 |
|
138 |
110 |
$0.00 |