| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,438 |
1,516 |
$256K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,396 |
1,043 |
$229K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,613 |
1,157 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,155 |
322 |
$164K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,001 |
988 |
$138K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,434 |
2,846 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,189 |
2,127 |
$73K |
| D1120 |
Prophylaxis - child |
2,000 |
1,945 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,977 |
1,820 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,043 |
2,949 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,493 |
2,423 |
$34K |
| D0274 |
Bitewings - four radiographic images |
850 |
828 |
$28K |
| D9248 |
|
183 |
175 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
701 |
697 |
$20K |
| D1110 |
Prophylaxis - adult |
296 |
291 |
$15K |
| D0272 |
Bitewings - two radiographic images |
589 |
579 |
$13K |
| D0350 |
|
767 |
716 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
107 |
44 |
$9K |
| D2330 |
|
22 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$896.84 |
| D9986 |
|
12 |
12 |
$0.00 |
| D0603 |
|
4,066 |
3,994 |
$0.00 |