| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
6,397 |
1,080 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,731 |
477 |
$155K |
| D0145 |
Oral evaluation for a patient under three years of age |
940 |
903 |
$124K |
| D1120 |
Prophylaxis - child |
2,851 |
2,781 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,120 |
3,039 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,453 |
3,065 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
634 |
299 |
$47K |
| D1110 |
Prophylaxis - adult |
893 |
873 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,197 |
1,166 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,386 |
3,240 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
556 |
541 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,284 |
1,254 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,981 |
1,920 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,795 |
1,768 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
557 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
14 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
25 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
67 |
$2K |
| D0330 |
Panoramic radiographic image |
91 |
84 |
$990.88 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$319.26 |
| D0601 |
|
769 |
767 |
$0.00 |
| D0602 |
|
206 |
205 |
$0.00 |
| D0603 |
|
3,714 |
3,587 |
$0.00 |