| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
33,522 |
6,117 |
$1.02M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,398 |
3,168 |
$628K |
| D1120 |
Prophylaxis - child |
13,830 |
12,048 |
$549K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,054 |
2,779 |
$482K |
| D0120 |
Periodic oral evaluation - established patient |
16,079 |
13,911 |
$408K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,661 |
16,267 |
$389K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,541 |
6,373 |
$351K |
| D0330 |
Panoramic radiographic image |
4,478 |
3,974 |
$286K |
| D1110 |
Prophylaxis - adult |
4,694 |
4,054 |
$254K |
| D2740 |
Crown - porcelain/ceramic |
266 |
123 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,125 |
1,154 |
$173K |
| D0220 |
Intraoral - periapical first radiographic image |
9,383 |
8,163 |
$158K |
| D0274 |
Bitewings - four radiographic images |
3,624 |
3,408 |
$141K |
| D1354 |
|
2,116 |
500 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,342 |
2,982 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,375 |
1,207 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,699 |
7,055 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,614 |
2,969 |
$90K |
| D1320 |
|
2,735 |
2,350 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
482 |
317 |
$67K |
| D2950 |
|
346 |
168 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,150 |
1,027 |
$41K |
| D9630 |
|
1,603 |
1,563 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
123 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
483 |
471 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
14 |
$11K |
| D0999 |
Unspecified diagnostic procedure, by report |
40 |
19 |
$0.00 |
| D1330 |
|
43 |
21 |
$0.00 |