| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
6,027 |
5,975 |
$841K |
| D1120 |
Prophylaxis - child |
9,701 |
9,546 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
10,319 |
10,155 |
$277K |
| D9248 |
|
2,270 |
2,237 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,345 |
1,643 |
$217K |
| D0272 |
Bitewings - two radiographic images |
6,927 |
6,821 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,132 |
10,951 |
$151K |
| D1351 |
Sealant - per tooth |
4,644 |
1,413 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
9,591 |
9,300 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,577 |
6,460 |
$81K |
| D1110 |
Prophylaxis - adult |
1,449 |
1,429 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
570 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,387 |
1,362 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,159 |
$39K |
| D1354 |
|
2,810 |
1,344 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,186 |
1,161 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
106 |
12 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
13 |
$3K |
| D0270 |
|
493 |
490 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
70 |
$2K |
| D2330 |
|
19 |
12 |
$1K |
| D1330 |
|
9,585 |
9,472 |
$12.25 |
| D9430 |
|
613 |
599 |
$0.00 |
| D0603 |
|
17,544 |
17,323 |
$0.00 |