| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
23,836 |
4,881 |
$434K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,273 |
1,781 |
$352K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,617 |
2,574 |
$243K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,970 |
1,805 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
8,891 |
8,725 |
$186K |
| D1120 |
Prophylaxis - child |
6,874 |
6,745 |
$171K |
| D1110 |
Prophylaxis - adult |
4,296 |
4,212 |
$160K |
| D1206 |
Topical application of fluoride varnish |
11,207 |
10,993 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,723 |
1,684 |
$86K |
| D0274 |
Bitewings - four radiographic images |
4,451 |
4,361 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,619 |
9,944 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
10,581 |
10,328 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,897 |
2,840 |
$68K |
| D0272 |
Bitewings - two radiographic images |
4,416 |
4,326 |
$62K |
| D0330 |
Panoramic radiographic image |
1,275 |
1,260 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
37 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
30 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
54 |
$660.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
34 |
$460.95 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
27 |
$366.06 |
| D1330 |
|
1,745 |
1,688 |
$192.28 |
| D0603 |
|
12,052 |
11,843 |
$67.56 |
| D9310 |
|
13 |
13 |
$58.32 |
| D0602 |
|
1,879 |
1,844 |
$1.40 |
| D0601 |
|
133 |
125 |
$0.00 |