| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,243 |
2,221 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
9,958 |
9,831 |
$230K |
| D1351 |
Sealant - per tooth |
11,642 |
2,685 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,262 |
2,230 |
$217K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,930 |
497 |
$203K |
| D1120 |
Prophylaxis - child |
6,316 |
6,229 |
$172K |
| D1110 |
Prophylaxis - adult |
3,641 |
3,605 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,127 |
10,001 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,360 |
4,162 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
9,318 |
9,135 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,711 |
3,671 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,785 |
8,621 |
$69K |
| D0272 |
Bitewings - two radiographic images |
4,693 |
4,635 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
764 |
555 |
$57K |
| D0330 |
Panoramic radiographic image |
1,672 |
1,648 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
250 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
203 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
376 |
$11K |
| D0350 |
|
498 |
468 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
336 |
$4K |
| D9248 |
|
26 |
26 |
$1K |
| D1354 |
|
232 |
82 |
$742.22 |
| D2940 |
|
29 |
13 |
$591.57 |
| D0170 |
|
33 |
32 |
$289.45 |
| D7111 |
|
23 |
14 |
$126.24 |
| D0603 |
|
10,260 |
10,147 |
$0.00 |
| D0602 |
|
1,526 |
1,509 |
$0.00 |
| D0601 |
|
927 |
916 |
$0.00 |