| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,662 |
5,075 |
$682K |
| D1120 |
Prophylaxis - child |
16,280 |
15,603 |
$672K |
| D0120 |
Periodic oral evaluation - established patient |
16,235 |
15,534 |
$454K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,002 |
9,443 |
$257K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,130 |
2,245 |
$237K |
| D2160 |
|
2,235 |
1,633 |
$217K |
| D1206 |
Topical application of fluoride varnish |
5,987 |
5,874 |
$161K |
| D0274 |
Bitewings - four radiographic images |
6,306 |
6,019 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,233 |
1,044 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,315 |
3,158 |
$75K |
| D1110 |
Prophylaxis - adult |
1,397 |
1,338 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
8,032 |
7,734 |
$49K |
| D0272 |
Bitewings - two radiographic images |
4,641 |
4,402 |
$47K |
| D4341 |
|
246 |
145 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,512 |
5,309 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,550 |
1,492 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
354 |
291 |
$20K |
| D2140 |
|
305 |
247 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
61 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
47 |
$4K |
| D9310 |
|
64 |
64 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$163.60 |
| D1999 |
|
2,141 |
1,880 |
$0.00 |