| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
55,410 |
17,736 |
$1.35M |
| D1120 |
Prophylaxis - child |
52,522 |
51,376 |
$1.16M |
| D1208 |
Topical application of fluoride, excluding varnish |
66,301 |
64,882 |
$1.11M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,691 |
9,151 |
$959K |
| D0120 |
Periodic oral evaluation - established patient |
50,050 |
48,976 |
$955K |
| D0330 |
Panoramic radiographic image |
13,532 |
13,155 |
$704K |
| D2140 |
|
15,024 |
8,598 |
$668K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,129 |
3,757 |
$574K |
| D1110 |
Prophylaxis - adult |
14,594 |
14,327 |
$560K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,704 |
18,262 |
$546K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14,586 |
13,772 |
$408K |
| D0274 |
Bitewings - four radiographic images |
18,950 |
18,530 |
$389K |
| D0272 |
Bitewings - two radiographic images |
33,401 |
32,586 |
$339K |
| D0240 |
|
25,254 |
10,412 |
$269K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,718 |
2,810 |
$267K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,223 |
2,493 |
$205K |
| D2160 |
|
2,348 |
1,728 |
$181K |
| D0140 |
Limited oral evaluation - problem focused |
4,322 |
4,154 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,733 |
1,670 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
693 |
300 |
$47K |
| D2335 |
|
418 |
313 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
6,556 |
6,308 |
$35K |
| D0350 |
|
497 |
331 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
672 |
410 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
26 |
$3K |
| D1510 |
|
16 |
12 |
$2K |
| D0270 |
|
135 |
133 |
$620.00 |
| D0603 |
|
95 |
92 |
$0.00 |