| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
17,882 |
4,284 |
$422K |
| D0120 |
Periodic oral evaluation - established patient |
15,555 |
15,080 |
$422K |
| D1120 |
Prophylaxis - child |
17,136 |
16,597 |
$401K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,122 |
2,421 |
$291K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,447 |
1,859 |
$201K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,642 |
11,472 |
$198K |
| D9999 |
Unspecified adjunctive procedure, by report |
5,481 |
5,310 |
$163K |
| D1206 |
Topical application of fluoride varnish |
5,941 |
5,546 |
$154K |
| D0272 |
Bitewings - two radiographic images |
14,779 |
14,295 |
$146K |
| D0330 |
Panoramic radiographic image |
3,000 |
2,897 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,927 |
2,803 |
$115K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
724 |
361 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,439 |
4,027 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
982 |
597 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,436 |
4,238 |
$35K |
| D1110 |
Prophylaxis - adult |
848 |
802 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,586 |
1,489 |
$33K |
| D1999 |
|
1,701 |
1,587 |
$22K |
| D9248 |
|
86 |
81 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,833 |
1,659 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
12 |
$1K |
| D7111 |
|
36 |
25 |
$1K |
| D1354 |
|
46 |
14 |
$159.60 |