| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,452 |
2,428 |
$341K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,244 |
1,154 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
7,523 |
7,426 |
$203K |
| D1351 |
Sealant - per tooth |
7,600 |
2,140 |
$200K |
| D1120 |
Prophylaxis - child |
5,906 |
5,835 |
$199K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,157 |
505 |
$159K |
| D1110 |
Prophylaxis - adult |
2,048 |
2,021 |
$105K |
| D1206 |
Topical application of fluoride varnish |
7,608 |
7,519 |
$104K |
| D0272 |
Bitewings - two radiographic images |
4,485 |
4,427 |
$96K |
| D9248 |
|
753 |
702 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,111 |
715 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,341 |
5,734 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
6,482 |
6,331 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,674 |
1,650 |
$53K |
| D0330 |
Panoramic radiographic image |
912 |
897 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
899 |
829 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
408 |
396 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
107 |
53 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
319 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
224 |
217 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
41 |
$2K |
| D1354 |
|
49 |
20 |
$565.50 |
| D0603 |
|
11,230 |
11,108 |
$0.00 |