| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
13,664 |
2,335 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,219 |
969 |
$193K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,910 |
6,792 |
$162K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,362 |
1,318 |
$156K |
| D1120 |
Prophylaxis - child |
4,888 |
4,762 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
5,096 |
4,947 |
$121K |
| D1110 |
Prophylaxis - adult |
1,947 |
1,890 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,964 |
2,871 |
$77K |
| D1206 |
Topical application of fluoride varnish |
6,624 |
6,463 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
7,822 |
7,479 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,082 |
1,991 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
464 |
240 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,436 |
1,314 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
251 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,286 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
544 |
329 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
241 |
122 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
87 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
546 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
24 |
$1K |
| D2950 |
|
26 |
12 |
$1K |
| D0603 |
|
4,548 |
4,430 |
$46.25 |
| D0602 |
|
1,289 |
1,252 |
$10.01 |
| D0601 |
|
2,431 |
2,356 |
$0.01 |