| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,213 |
1,782 |
$372K |
| D9248 |
|
1,380 |
1,319 |
$360K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,151 |
940 |
$319K |
| D1120 |
Prophylaxis - child |
5,865 |
5,841 |
$218K |
| D0120 |
Periodic oral evaluation - established patient |
6,627 |
6,607 |
$196K |
| D1206 |
Topical application of fluoride varnish |
8,111 |
8,063 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,214 |
1,030 |
$159K |
| D1110 |
Prophylaxis - adult |
1,872 |
1,866 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,145 |
537 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,671 |
2,665 |
$62K |
| D2140 |
|
898 |
528 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,078 |
1,064 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,391 |
1,378 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
524 |
328 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
234 |
$41K |
| D0330 |
Panoramic radiographic image |
701 |
701 |
$40K |
| D1510 |
|
196 |
169 |
$39K |
| D2332 |
|
299 |
175 |
$35K |
| D0274 |
Bitewings - four radiographic images |
977 |
974 |
$33K |
| D2330 |
|
329 |
193 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,332 |
1,316 |
$17K |
| D0603 |
|
1,723 |
1,708 |
$13K |
| D1330 |
|
1,775 |
1,763 |
$11K |
| D1310 |
|
1,778 |
1,761 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
31 |
31 |
$10K |
| D1320 |
|
661 |
654 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
61 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
113 |
$7K |
| D9110 |
|
135 |
133 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
223 |
192 |
$2K |
| D0270 |
|
109 |
109 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$1K |
| D1999 |
|
28 |
25 |
$0.00 |