| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
15,074 |
2,690 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,448 |
1,333 |
$146K |
| D1120 |
Prophylaxis - child |
6,827 |
6,313 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
6,671 |
6,130 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,372 |
1,317 |
$97K |
| D1110 |
Prophylaxis - adult |
2,806 |
2,566 |
$91K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,276 |
1,053 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,193 |
2,961 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,247 |
7,580 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,319 |
3,028 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
635 |
261 |
$59K |
| D0272 |
Bitewings - two radiographic images |
4,765 |
4,426 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
556 |
556 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,867 |
4,487 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,245 |
3,780 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,344 |
1,098 |
$22K |
| D0330 |
Panoramic radiographic image |
2,092 |
1,962 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
195 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,272 |
1,211 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
590 |
502 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
57 |
15 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
42 |
$3K |
| D0350 |
|
28 |
28 |
$202.18 |
| D0270 |
|
50 |
46 |
$135.03 |
| D0603 |
|
7,417 |
6,524 |
$0.00 |
| D0602 |
|
2,606 |
2,499 |
$0.00 |
| D0601 |
|
1,017 |
935 |
$0.00 |
| D1999 |
|
357 |
293 |
$0.00 |