| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,434 |
1,500 |
$197K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,258 |
1,249 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
872 |
321 |
$125K |
| D1120 |
Prophylaxis - child |
3,335 |
3,297 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
853 |
406 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,943 |
2,889 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,845 |
2,805 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,636 |
3,573 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,593 |
3,542 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,831 |
3,721 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
697 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
812 |
772 |
$20K |
| D1110 |
Prophylaxis - adult |
347 |
328 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
103 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
170 |
84 |
$13K |
| D9248 |
|
122 |
117 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
99 |
$10K |
| D0274 |
Bitewings - four radiographic images |
385 |
366 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |
| D1206 |
Topical application of fluoride varnish |
73 |
70 |
$940.80 |
| D0330 |
Panoramic radiographic image |
151 |
141 |
$857.50 |
| D0601 |
|
1,344 |
1,322 |
$0.00 |
| D0603 |
|
3,784 |
3,746 |
$0.00 |
| D0602 |
|
30 |
29 |
$0.00 |