| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
10,261 |
2,788 |
$368K |
| D1120 |
Prophylaxis - child |
7,501 |
7,267 |
$308K |
| D1206 |
Topical application of fluoride varnish |
10,877 |
10,460 |
$299K |
| D0330 |
Panoramic radiographic image |
2,686 |
2,606 |
$224K |
| D1110 |
Prophylaxis - adult |
3,348 |
3,263 |
$188K |
| D9410 |
|
5,547 |
4,987 |
$157K |
| D1330 |
|
5,947 |
5,691 |
$142K |
| D0274 |
Bitewings - four radiographic images |
3,360 |
3,294 |
$141K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
738 |
304 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
2,890 |
2,833 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,046 |
653 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,396 |
2,284 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,288 |
751 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,044 |
1,964 |
$97K |
| D1310 |
|
1,042 |
1,031 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,121 |
1,113 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
414 |
259 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
1,828 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
196 |
$30K |
| D2140 |
|
128 |
80 |
$11K |
| D2331 |
|
67 |
46 |
$8K |
| D1354 |
|
231 |
41 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
671 |
394 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
29 |
$5K |
| D2160 |
|
36 |
26 |
$5K |
| D2330 |
|
44 |
27 |
$3K |
| D2335 |
|
20 |
13 |
$3K |
| D2161 |
|
16 |
12 |
$3K |
| D9985 |
|
4,996 |
4,094 |
$25.38 |
| D3120 |
|
93 |
68 |
$0.00 |