| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
17,288 |
2,109 |
$503K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,935 |
1,664 |
$337K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,164 |
687 |
$264K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,383 |
1,445 |
$226K |
| D1120 |
Prophylaxis - child |
5,734 |
5,084 |
$217K |
| D0330 |
Panoramic radiographic image |
3,415 |
3,158 |
$200K |
| D1110 |
Prophylaxis - adult |
3,676 |
3,363 |
$198K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,736 |
7,665 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,214 |
6,308 |
$179K |
| D2740 |
Crown - porcelain/ceramic |
224 |
144 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,168 |
5,304 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
3,307 |
3,076 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,790 |
466 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
6,999 |
6,265 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,458 |
1,201 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,744 |
1,660 |
$65K |
| D2950 |
|
476 |
340 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,719 |
1,617 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
400 |
275 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
549 |
521 |
$40K |
| D9310 |
|
723 |
655 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,387 |
1,185 |
$32K |
| D1320 |
|
1,015 |
886 |
$28K |
| D1354 |
|
489 |
120 |
$27K |
| D9630 |
|
1,018 |
942 |
$17K |
| D2331 |
|
45 |
32 |
$5K |
| D4341 |
|
25 |
14 |
$4K |
| D0350 |
|
54 |
53 |
$1K |
| D0180 |
|
13 |
13 |
$600.00 |
| D1999 |
|
32 |
14 |
$0.00 |