| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,234 |
1,361 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
6,485 |
6,448 |
$183K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,775 |
1,108 |
$167K |
| D1120 |
Prophylaxis - child |
4,612 |
4,591 |
$165K |
| D0145 |
Oral evaluation for a patient under three years of age |
903 |
900 |
$126K |
| D1110 |
Prophylaxis - adult |
2,378 |
2,359 |
$124K |
| D9248 |
|
1,044 |
998 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,048 |
7,009 |
$101K |
| D0272 |
Bitewings - two radiographic images |
3,902 |
3,888 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,373 |
6,313 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,051 |
6,009 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,963 |
1,948 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
788 |
783 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
261 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
847 |
813 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
97 |
76 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
223 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
105 |
$2K |
| D1999 |
|
727 |
715 |
$0.00 |
| D9986 |
|
177 |
172 |
$0.00 |
| D0602 |
|
3,514 |
3,496 |
$0.00 |
| D0603 |
|
4,415 |
4,385 |
$0.00 |
| D1330 |
|
65 |
65 |
$0.00 |