| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
19,605 |
3,902 |
$480K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,870 |
2,518 |
$458K |
| D1120 |
Prophylaxis - child |
16,529 |
14,986 |
$429K |
| D0120 |
Periodic oral evaluation - established patient |
13,799 |
13,246 |
$364K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,449 |
18,567 |
$324K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,673 |
5,394 |
$248K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,290 |
1,786 |
$193K |
| D0330 |
Panoramic radiographic image |
2,951 |
2,540 |
$152K |
| D1110 |
Prophylaxis - adult |
3,986 |
3,700 |
$149K |
| D0272 |
Bitewings - two radiographic images |
8,220 |
7,281 |
$140K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,028 |
2,129 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,336 |
1,000 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
7,384 |
6,087 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,234 |
2,038 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,527 |
4,299 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,148 |
1,063 |
$42K |
| D7111 |
|
411 |
183 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
37 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
32 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
33 |
25 |
$3K |