| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,551 |
3,060 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,106 |
1,323 |
$305K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,975 |
1,945 |
$274K |
| D1120 |
Prophylaxis - child |
6,202 |
6,164 |
$224K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,505 |
430 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
6,706 |
6,665 |
$191K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,539 |
6,432 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,592 |
715 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,787 |
1,775 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,282 |
8,227 |
$120K |
| D1110 |
Prophylaxis - adult |
2,003 |
1,990 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
6,791 |
6,728 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,445 |
2,434 |
$83K |
| D9248 |
|
542 |
492 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,489 |
1,479 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,904 |
1,817 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,406 |
1,400 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
90 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
49 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
365 |
355 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
27 |
$4K |
| D0603 |
|
10,507 |
10,420 |
$0.00 |