| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
25,559 |
5,690 |
$685K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,563 |
4,510 |
$634K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,091 |
1,897 |
$586K |
| D1120 |
Prophylaxis - child |
13,762 |
13,585 |
$493K |
| D0120 |
Periodic oral evaluation - established patient |
16,051 |
15,850 |
$454K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,437 |
2,323 |
$261K |
| D9248 |
|
2,187 |
2,131 |
$257K |
| D0272 |
Bitewings - two radiographic images |
10,547 |
10,403 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,383 |
1,723 |
$229K |
| D1110 |
Prophylaxis - adult |
4,066 |
4,013 |
$218K |
| D0210 |
Intraoral - complete series of radiographic images |
3,010 |
2,971 |
$202K |
| D0220 |
Intraoral - periapical first radiographic image |
15,585 |
15,281 |
$189K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,266 |
12,114 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,881 |
14,291 |
$166K |
| D0274 |
Bitewings - four radiographic images |
3,075 |
3,036 |
$104K |
| D1206 |
Topical application of fluoride varnish |
5,370 |
5,296 |
$77K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
900 |
510 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,025 |
1,990 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,174 |
2,093 |
$57K |
| D0330 |
Panoramic radiographic image |
471 |
469 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
448 |
304 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
785 |
$15K |
| D2934 |
|
31 |
13 |
$5K |
| D0603 |
|
22,931 |
22,572 |
$0.00 |