| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
15,283 |
4,158 |
$158K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,039 |
284 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,438 |
815 |
$133K |
| D1120 |
Prophylaxis - child |
2,980 |
2,873 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,520 |
3,381 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
526 |
507 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,136 |
3,967 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,670 |
4,456 |
$54K |
| D1110 |
Prophylaxis - adult |
1,021 |
969 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,432 |
1,372 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,323 |
1,182 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
783 |
750 |
$26K |
| D1351 |
Sealant - per tooth |
884 |
322 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
382 |
187 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
122 |
$14K |
| D2335 |
|
69 |
25 |
$9K |
| D0272 |
Bitewings - two radiographic images |
313 |
298 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
76 |
37 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
53 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
97 |
$2K |
| D9248 |
|
15 |
12 |
$1K |
| D1330 |
|
57 |
55 |
$612.50 |
| D0603 |
|
5,401 |
5,193 |
$0.00 |