| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
39,500 |
8,067 |
$730K |
| D1120 |
Prophylaxis - child |
25,303 |
25,222 |
$663K |
| D0120 |
Periodic oral evaluation - established patient |
23,245 |
23,162 |
$492K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,985 |
6,819 |
$417K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,437 |
3,916 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,369 |
20,324 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,778 |
2,670 |
$146K |
| D0330 |
Panoramic radiographic image |
5,024 |
5,006 |
$132K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,408 |
1,141 |
$114K |
| D1206 |
Topical application of fluoride varnish |
6,144 |
6,095 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,614 |
1,409 |
$75K |
| D0273 |
|
7,432 |
7,362 |
$75K |
| D0603 |
|
8,910 |
8,839 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,668 |
2,656 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,252 |
1,014 |
$42K |
| D0602 |
|
2,794 |
2,767 |
$23K |
| D7111 |
|
464 |
349 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,271 |
2,266 |
$15K |
| D1110 |
Prophylaxis - adult |
636 |
632 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
642 |
641 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
339 |
339 |
$6K |
| D2330 |
|
154 |
109 |
$5K |
| D0601 |
|
469 |
465 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
226 |
205 |
$2K |
| D2331 |
|
51 |
39 |
$2K |
| D1510 |
|
13 |
12 |
$1K |
| D2332 |
|
18 |
12 |
$805.00 |
| D2394 |
|
12 |
12 |
$590.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$540.00 |
| D9986 |
|
1,900 |
1,823 |
$0.00 |