| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
136,014 |
32,786 |
$2.25M |
| D1120 |
Prophylaxis - child |
73,774 |
73,623 |
$1.77M |
| D0120 |
Periodic oral evaluation - established patient |
75,851 |
75,692 |
$1.46M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29,775 |
19,638 |
$1.22M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,245 |
14,045 |
$691K |
| D1208 |
Topical application of fluoride, excluding varnish |
69,171 |
69,045 |
$597K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,723 |
8,520 |
$404K |
| D0330 |
Panoramic radiographic image |
15,283 |
15,240 |
$354K |
| D0273 |
|
32,374 |
32,324 |
$278K |
| D1206 |
Topical application of fluoride varnish |
12,826 |
12,751 |
$208K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,440 |
1,963 |
$201K |
| D0603 |
|
22,532 |
22,487 |
$161K |
| D1110 |
Prophylaxis - adult |
7,822 |
7,798 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,206 |
2,822 |
$147K |
| D0602 |
|
16,578 |
16,521 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
5,833 |
5,814 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,428 |
5,409 |
$89K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,361 |
1,896 |
$78K |
| D2330 |
|
1,852 |
1,261 |
$61K |
| D2332 |
|
1,177 |
755 |
$53K |
| D2331 |
|
1,222 |
916 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,520 |
2,506 |
$39K |
| D7111 |
|
973 |
726 |
$35K |
| D2750 |
|
45 |
40 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,963 |
1,961 |
$12K |
| D2335 |
|
127 |
91 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$4K |
| D0601 |
|
634 |
634 |
$4K |
| D2950 |
|
48 |
38 |
$2K |
| D0270 |
|
444 |
443 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$1K |
| D2394 |
|
13 |
12 |
$780.00 |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
84 |
$279.15 |
| D0350 |
|
152 |
152 |
$263.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
79 |
79 |
$0.00 |
| D9986 |
|
5,808 |
5,489 |
$0.00 |