| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,724 |
2,695 |
$376K |
| D1120 |
Prophylaxis - child |
8,574 |
8,351 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,908 |
1,457 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
9,228 |
8,948 |
$252K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,783 |
744 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,476 |
10,194 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,776 |
1,011 |
$130K |
| D0272 |
Bitewings - two radiographic images |
4,887 |
4,773 |
$110K |
| D1110 |
Prophylaxis - adult |
2,118 |
2,061 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
7,550 |
7,308 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,030 |
2,883 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,572 |
6,272 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,249 |
735 |
$63K |
| D1351 |
Sealant - per tooth |
2,357 |
796 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
716 |
405 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,447 |
1,395 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,391 |
1,341 |
$46K |
| D0330 |
Panoramic radiographic image |
490 |
467 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,238 |
1,210 |
$22K |
| D2335 |
|
66 |
27 |
$9K |
| D1999 |
|
1,567 |
1,512 |
$0.00 |
| D0603 |
|
13,034 |
12,858 |
$0.00 |
| D0601 |
|
45 |
45 |
$0.00 |