| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
13,215 |
2,403 |
$351K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,469 |
436 |
$217K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,224 |
1,196 |
$167K |
| D1120 |
Prophylaxis - child |
4,043 |
3,979 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
3,657 |
3,590 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,405 |
1,383 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,152 |
5,067 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,972 |
2,922 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
640 |
263 |
$64K |
| D1110 |
Prophylaxis - adult |
1,057 |
1,034 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,477 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,072 |
3,983 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,972 |
3,768 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
197 |
$29K |
| D0274 |
Bitewings - four radiographic images |
595 |
580 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
173 |
73 |
$15K |
| D9248 |
|
51 |
51 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
100 |
$2K |
| D0602 |
|
1,202 |
1,169 |
$0.00 |
| D0603 |
|
2,627 |
2,575 |
$0.00 |
| D0601 |
|
2,525 |
2,479 |
$0.00 |