| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
119,853 |
39,814 |
$1.17M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
7,641 |
2,432 |
$1.12M |
| D0145 |
Oral evaluation for a patient under three years of age |
7,620 |
7,580 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
35,597 |
35,468 |
$1.01M |
| D1120 |
Prophylaxis - child |
25,546 |
25,449 |
$924K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,617 |
4,466 |
$862K |
| D1351 |
Sealant - per tooth |
30,238 |
6,043 |
$836K |
| D1110 |
Prophylaxis - adult |
15,335 |
15,279 |
$822K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,108 |
41,938 |
$609K |
| D0220 |
Intraoral - periapical first radiographic image |
43,317 |
43,080 |
$499K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,757 |
3,146 |
$447K |
| D0274 |
Bitewings - four radiographic images |
11,484 |
11,435 |
$306K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,206 |
1,282 |
$265K |
| D0272 |
Bitewings - two radiographic images |
13,550 |
13,491 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,749 |
5,724 |
$198K |
| D7240 |
Removal of impacted tooth - completely bony |
657 |
219 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
2,211 |
2,208 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,691 |
4,465 |
$126K |
| D7140 |
Extraction, erupted tooth or exposed root |
914 |
535 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,323 |
1,320 |
$24K |
| D9243 |
|
619 |
210 |
$24K |
| D9248 |
|
123 |
120 |
$15K |
| D9239 |
|
215 |
210 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
45 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
28 |
$4K |
| D0270 |
|
62 |
61 |
$266.19 |
| D0603 |
|
22,775 |
22,681 |
$0.06 |
| D0602 |
|
27,422 |
27,304 |
$0.01 |
| D0601 |
|
188 |
187 |
$0.00 |