| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
56,439 |
11,490 |
$507K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,326 |
3,235 |
$454K |
| D1351 |
Sealant - per tooth |
15,153 |
3,765 |
$406K |
| D1120 |
Prophylaxis - child |
9,492 |
9,176 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
11,109 |
10,728 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,094 |
2,001 |
$306K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,984 |
1,106 |
$275K |
| D9248 |
|
2,445 |
2,301 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,091 |
11,681 |
$171K |
| D0220 |
Intraoral - periapical first radiographic image |
14,327 |
13,422 |
$154K |
| D1110 |
Prophylaxis - adult |
2,563 |
2,460 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
809 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,035 |
2,005 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
423 |
295 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
874 |
859 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
999 |
999 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,044 |
924 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,350 |
1,312 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
266 |
187 |
$22K |
| D7111 |
|
402 |
287 |
$5K |
| D0330 |
Panoramic radiographic image |
111 |
109 |
$3K |
| D0274 |
Bitewings - four radiographic images |
87 |
85 |
$3K |
| D9630 |
|
62 |
57 |
$256.02 |
| D0350 |
|
37 |
29 |
$110.28 |
| D0270 |
|
17 |
16 |
$63.70 |
| D9986 |
|
1,290 |
1,222 |
$0.00 |
| D0603 |
|
15,503 |
14,985 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
68 |
53 |
$0.00 |