| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,101 |
2,725 |
$382K |
| D1120 |
Prophylaxis - child |
8,641 |
8,347 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
9,211 |
8,907 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,538 |
8,245 |
$221K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,275 |
1,582 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,696 |
2,084 |
$160K |
| D1110 |
Prophylaxis - adult |
3,104 |
3,029 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,987 |
4,806 |
$112K |
| D0274 |
Bitewings - four radiographic images |
4,468 |
4,303 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
2,449 |
2,361 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
10,147 |
9,696 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,891 |
7,853 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,698 |
2,585 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
590 |
520 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
462 |
385 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
470 |
420 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,831 |
1,749 |
$18K |
| D4341 |
|
123 |
81 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
366 |
320 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
148 |
119 |
$9K |
| D2950 |
|
114 |
107 |
$6K |
| D9110 |
|
70 |
68 |
$4K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D2160 |
|
12 |
12 |
$1K |
| D2140 |
|
12 |
12 |
$431.90 |
| D0270 |
|
28 |
27 |
$156.80 |