| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,755 |
5,658 |
$791K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,429 |
1,910 |
$749K |
| D1351 |
Sealant - per tooth |
24,481 |
6,919 |
$640K |
| D1120 |
Prophylaxis - child |
15,149 |
14,823 |
$529K |
| D0120 |
Periodic oral evaluation - established patient |
18,365 |
17,951 |
$508K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,858 |
19,443 |
$280K |
| D0272 |
Bitewings - two radiographic images |
11,840 |
11,550 |
$266K |
| D1110 |
Prophylaxis - adult |
4,867 |
4,764 |
$254K |
| D0220 |
Intraoral - periapical first radiographic image |
20,264 |
19,694 |
$243K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,124 |
2,249 |
$229K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,370 |
1,754 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,047 |
18,452 |
$219K |
| D0274 |
Bitewings - four radiographic images |
5,823 |
5,696 |
$194K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,211 |
5,823 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,856 |
1,734 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
838 |
449 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
639 |
609 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,160 |
1,135 |
$21K |
| D1354 |
|
1,219 |
374 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
123 |
56 |
$9K |
| D1330 |
|
363 |
357 |
$4K |
| D7111 |
|
195 |
146 |
$2K |
| D3120 |
|
33 |
25 |
$28.67 |
| D0603 |
|
26,349 |
25,849 |
$0.00 |