| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,224 |
1,096 |
$159K |
| D1120 |
Prophylaxis - child |
2,823 |
2,714 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,300 |
3,176 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
983 |
456 |
$84K |
| D0145 |
Oral evaluation for a patient under three years of age |
619 |
602 |
$83K |
| D7240 |
Removal of impacted tooth - completely bony |
295 |
88 |
$78K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
600 |
234 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,339 |
2,243 |
$50K |
| D1206 |
Topical application of fluoride varnish |
3,286 |
3,170 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,968 |
3,690 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,952 |
3,400 |
$39K |
| D1110 |
Prophylaxis - adult |
701 |
670 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
273 |
$28K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
333 |
143 |
$23K |
| D9248 |
|
234 |
222 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
859 |
813 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
203 |
$18K |
| D0274 |
Bitewings - four radiographic images |
519 |
499 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
252 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
392 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
487 |
458 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
147 |
140 |
$2K |
| D2332 |
|
15 |
12 |
$2K |
| D7111 |
|
77 |
47 |
$774.62 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$376.66 |
| D1999 |
|
1,326 |
1,197 |
$5.00 |
| D0603 |
|
4,675 |
4,572 |
$0.00 |