| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,649 |
2,665 |
$265K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,980 |
1,375 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
6,413 |
6,132 |
$144K |
| D1120 |
Prophylaxis - child |
4,501 |
4,280 |
$114K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,007 |
978 |
$97K |
| D1110 |
Prophylaxis - adult |
2,455 |
2,363 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,581 |
905 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,570 |
3,399 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,200 |
6,574 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,081 |
6,751 |
$72K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
696 |
214 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
7,238 |
6,868 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,107 |
2,026 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,760 |
1,650 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
568 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
145 |
123 |
$2K |
| D1330 |
|
205 |
204 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$832.78 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$774.48 |
| D0603 |
|
6,115 |
5,766 |
$10.12 |
| D0602 |
|
2,267 |
2,237 |
$0.16 |