| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
9,892 |
1,544 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
10,486 |
9,890 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,929 |
10,300 |
$200K |
| D1120 |
Prophylaxis - child |
6,808 |
6,436 |
$197K |
| D1110 |
Prophylaxis - adult |
4,404 |
4,134 |
$182K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,823 |
1,856 |
$164K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,518 |
5,273 |
$161K |
| D2140 |
|
2,524 |
1,713 |
$124K |
| D0272 |
Bitewings - two radiographic images |
5,295 |
5,019 |
$109K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
862 |
617 |
$104K |
| D0330 |
Panoramic radiographic image |
1,866 |
1,770 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
863 |
588 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
634 |
356 |
$56K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
591 |
432 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
612 |
377 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
878 |
827 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
932 |
812 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,336 |
$14K |
| D2332 |
|
59 |
41 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
228 |
118 |
$2K |