| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
14,478 |
3,633 |
$387K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,511 |
1,868 |
$342K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,437 |
2,401 |
$338K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,451 |
1,379 |
$185K |
| D1120 |
Prophylaxis - child |
5,109 |
5,016 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
6,349 |
6,239 |
$178K |
| D1110 |
Prophylaxis - adult |
2,781 |
2,738 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,914 |
7,776 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,291 |
3,240 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,115 |
3,712 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
6,940 |
6,779 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,735 |
6,467 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,082 |
1,048 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,896 |
2,842 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,440 |
1,405 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
25 |
$5K |
| D0330 |
Panoramic radiographic image |
290 |
285 |
$4K |
| D2330 |
|
22 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$467.62 |
| D0603 |
|
8,675 |
8,507 |
$0.02 |
| D0602 |
|
1,729 |
1,702 |
$0.00 |