| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,999 |
984 |
$131K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,014 |
1,931 |
$88K |
| D1120 |
Prophylaxis - child |
2,793 |
2,741 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,982 |
3,913 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,438 |
3,374 |
$72K |
| D1110 |
Prophylaxis - adult |
1,206 |
1,191 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
725 |
534 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,320 |
1,302 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
396 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,949 |
1,910 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
317 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
196 |
178 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
214 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,502 |
1,487 |
$13K |
| D1330 |
|
1,859 |
1,857 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,209 |
1,176 |
$10K |
| D2140 |
|
184 |
156 |
$9K |
| D0603 |
|
745 |
745 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
305 |
305 |
$6K |
| D0602 |
|
618 |
617 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
272 |
$6K |
| D2160 |
|
87 |
77 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32 |
28 |
$2K |
| D0601 |
|
224 |
224 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$1K |
| D9110 |
|
24 |
24 |
$795.81 |