| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
23,862 |
4,579 |
$426K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,859 |
1,998 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
7,994 |
7,941 |
$171K |
| D1110 |
Prophylaxis - adult |
4,358 |
4,322 |
$166K |
| D1120 |
Prophylaxis - child |
6,240 |
6,190 |
$159K |
| D0274 |
Bitewings - four radiographic images |
4,948 |
4,905 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,103 |
10,022 |
$103K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
946 |
458 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,841 |
2,803 |
$75K |
| D0145 |
Oral evaluation for a patient under three years of age |
812 |
792 |
$70K |
| D0272 |
Bitewings - two radiographic images |
4,500 |
4,464 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
7,851 |
7,757 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,081 |
2,770 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,559 |
7,343 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
793 |
789 |
$50K |
| D7240 |
Removal of impacted tooth - completely bony |
250 |
75 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
469 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
392 |
270 |
$26K |
| D0330 |
Panoramic radiographic image |
2,267 |
2,233 |
$19K |
| D1206 |
Topical application of fluoride varnish |
611 |
608 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
386 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
12 |
$2K |
| D1999 |
|
205 |
179 |
$0.00 |
| D0603 |
|
5,067 |
5,021 |
$0.00 |
| D0601 |
|
2,384 |
2,368 |
$0.00 |
| D0602 |
|
4,052 |
4,040 |
$0.00 |