| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
15,604 |
2,808 |
$524K |
| D1120 |
Prophylaxis - child |
11,566 |
11,352 |
$489K |
| D0120 |
Periodic oral evaluation - established patient |
12,257 |
12,030 |
$351K |
| D1206 |
Topical application of fluoride varnish |
13,526 |
13,278 |
$326K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,293 |
1,513 |
$278K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,389 |
725 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,735 |
1,177 |
$160K |
| D1110 |
Prophylaxis - adult |
2,260 |
2,220 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
979 |
591 |
$102K |
| D0272 |
Bitewings - two radiographic images |
6,132 |
6,037 |
$92K |
| D0330 |
Panoramic radiographic image |
1,650 |
1,619 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,441 |
1,397 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,790 |
2,733 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,066 |
2,992 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
890 |
873 |
$46K |
| D1330 |
|
7,165 |
7,042 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,853 |
2,768 |
$27K |
| D0240 |
|
1,375 |
1,345 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
389 |
382 |
$16K |
| D9310 |
|
305 |
303 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
621 |
$14K |
| D3120 |
|
372 |
305 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
243 |
$2K |
| D0270 |
|
12 |
12 |
$108.00 |