| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,244 |
2,111 |
$307K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,581 |
1,148 |
$253K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,634 |
472 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
6,551 |
6,512 |
$187K |
| D1120 |
Prophylaxis - child |
5,136 |
5,090 |
$185K |
| D9248 |
|
1,077 |
1,029 |
$126K |
| D0145 |
Oral evaluation for a patient under three years of age |
862 |
846 |
$118K |
| D1110 |
Prophylaxis - adult |
1,915 |
1,901 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,896 |
6,836 |
$100K |
| D0272 |
Bitewings - two radiographic images |
3,663 |
3,609 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,736 |
1,723 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
591 |
208 |
$48K |
| D0330 |
Panoramic radiographic image |
726 |
725 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,172 |
1,123 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
467 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,284 |
1,236 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
94 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
298 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
485 |
451 |
$5K |
| D9420 |
|
74 |
74 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D3120 |
|
14 |
13 |
$114.68 |
| D0603 |
|
4,438 |
4,379 |
$0.00 |
| D0602 |
|
3,167 |
3,128 |
$0.00 |
| D0601 |
|
435 |
430 |
$0.00 |