| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
9,880 |
9,790 |
$1.37M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,623 |
2,711 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
33,318 |
32,983 |
$930K |
| D1120 |
Prophylaxis - child |
25,431 |
25,103 |
$895K |
| D1351 |
Sealant - per tooth |
24,410 |
4,800 |
$625K |
| D1110 |
Prophylaxis - adult |
9,646 |
9,554 |
$512K |
| D1208 |
Topical application of fluoride, excluding varnish |
35,075 |
34,659 |
$498K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,648 |
10,304 |
$285K |
| D0350 |
|
27,505 |
26,317 |
$252K |
| D0272 |
Bitewings - two radiographic images |
11,486 |
11,352 |
$239K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,203 |
2,176 |
$231K |
| D2934 |
|
1,655 |
449 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,944 |
1,452 |
$178K |
| D0330 |
Panoramic radiographic image |
5,127 |
5,054 |
$159K |
| D0220 |
Intraoral - periapical first radiographic image |
14,314 |
13,892 |
$154K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,877 |
5,717 |
$146K |
| D0274 |
Bitewings - four radiographic images |
5,075 |
5,015 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
2,246 |
2,217 |
$132K |
| D9248 |
|
1,006 |
979 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,946 |
1,829 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
755 |
359 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,046 |
603 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,720 |
1,695 |
$31K |
| D0270 |
|
1,751 |
1,734 |
$8K |
| D2330 |
|
22 |
13 |
$911.14 |
| D7111 |
|
18 |
12 |
$183.52 |
| D0603 |
|
44,864 |
44,394 |
$0.00 |
| D0601 |
|
569 |
569 |
$0.00 |