| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,047 |
2,968 |
$413K |
| D1120 |
Prophylaxis - child |
7,115 |
6,928 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,550 |
1,087 |
$231K |
| D1351 |
Sealant - per tooth |
6,846 |
1,203 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
6,359 |
6,209 |
$173K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,041 |
443 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,132 |
6,973 |
$101K |
| D0272 |
Bitewings - two radiographic images |
3,904 |
3,792 |
$83K |
| D9248 |
|
517 |
475 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,378 |
4,069 |
$48K |
| D0330 |
Panoramic radiographic image |
954 |
933 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,303 |
1,238 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,403 |
2,884 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
609 |
347 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
397 |
172 |
$32K |
| D1110 |
Prophylaxis - adult |
521 |
501 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
878 |
815 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,157 |
1,093 |
$20K |
| D0274 |
Bitewings - four radiographic images |
129 |
123 |
$4K |
| D0350 |
|
323 |
316 |
$2K |
| D1330 |
|
218 |
212 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$976.40 |
| D1206 |
Topical application of fluoride varnish |
62 |
54 |
$355.24 |
| D0603 |
|
10,635 |
10,411 |
$0.00 |