| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,404 |
1,346 |
$171K |
| D0145 |
Oral evaluation for a patient under three years of age |
898 |
829 |
$113K |
| D1120 |
Prophylaxis - child |
3,260 |
2,996 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,157 |
2,836 |
$75K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
493 |
184 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,847 |
2,594 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
269 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,436 |
3,135 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,205 |
3,196 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,757 |
3,414 |
$39K |
| D1110 |
Prophylaxis - adult |
608 |
483 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
747 |
667 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
545 |
495 |
$16K |
| D0274 |
Bitewings - four radiographic images |
732 |
605 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
27 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
130 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$707.56 |
| D0330 |
Panoramic radiographic image |
61 |
57 |
$611.43 |
| D0603 |
|
4,004 |
3,690 |
$18.00 |
| D0601 |
|
702 |
640 |
$0.01 |
| D0602 |
|
29 |
26 |
$0.00 |