| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,168 |
2,165 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,975 |
1,445 |
$198K |
| D1120 |
Prophylaxis - child |
6,891 |
6,724 |
$181K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,984 |
1,922 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
6,663 |
6,549 |
$145K |
| D1110 |
Prophylaxis - adult |
3,156 |
3,093 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,153 |
1,140 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,042 |
386 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,711 |
3,551 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,380 |
9,160 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,928 |
3,843 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
9,856 |
9,545 |
$75K |
| D0272 |
Bitewings - two radiographic images |
5,019 |
4,886 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,057 |
1,055 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,513 |
7,769 |
$59K |
| D0330 |
Panoramic radiographic image |
2,981 |
2,874 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
211 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,111 |
1,005 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
161 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
12 |
$9K |
| D1206 |
Topical application of fluoride varnish |
587 |
581 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
85 |
28 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
259 |
$4K |
| D7111 |
|
276 |
160 |
$2K |
| D2330 |
|
27 |
14 |
$1K |
| D0270 |
|
49 |
46 |
$147.00 |
| D0350 |
|
15 |
15 |
$137.85 |
| D0603 |
|
8,196 |
8,035 |
$0.00 |
| D0602 |
|
3,240 |
3,163 |
$0.00 |
| D0601 |
|
496 |
472 |
$0.00 |
| D1999 |
|
324 |
239 |
$0.00 |