| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
19,832 |
3,458 |
$367K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,684 |
2,874 |
$323K |
| D1120 |
Prophylaxis - child |
10,148 |
10,085 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
10,435 |
10,366 |
$213K |
| D1110 |
Prophylaxis - adult |
5,451 |
5,400 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,937 |
911 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,222 |
2,172 |
$160K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,847 |
1,839 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,673 |
5,589 |
$146K |
| D0274 |
Bitewings - four radiographic images |
5,949 |
5,899 |
$116K |
| D1206 |
Topical application of fluoride varnish |
9,988 |
9,942 |
$109K |
| D0272 |
Bitewings - two radiographic images |
7,078 |
7,038 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,521 |
1,498 |
$91K |
| D0330 |
Panoramic radiographic image |
4,407 |
4,368 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
7,516 |
7,374 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
688 |
522 |
$53K |
| D7240 |
Removal of impacted tooth - completely bony |
262 |
92 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,840 |
2,603 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,216 |
5,173 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,578 |
5,586 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
346 |
100 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,268 |
1,242 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
235 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
130 |
26 |
$6K |
| D0350 |
|
364 |
358 |
$3K |
| D2330 |
|
38 |
25 |
$2K |
| D7111 |
|
107 |
73 |
$881.43 |
| D0270 |
|
112 |
112 |
$447.80 |
| D0603 |
|
12,955 |
12,907 |
$28.18 |
| D0602 |
|
2,848 |
2,834 |
$0.00 |
| D0601 |
|
915 |
909 |
$0.00 |
| D1999 |
|
599 |
486 |
$0.00 |