| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,708 |
2,692 |
$378K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,510 |
1,450 |
$348K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,188 |
8,286 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
8,131 |
8,093 |
$232K |
| D1120 |
Prophylaxis - child |
6,407 |
6,371 |
$231K |
| D1110 |
Prophylaxis - adult |
2,487 |
2,479 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,146 |
9,095 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,658 |
777 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
764 |
287 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
8,851 |
8,746 |
$108K |
| D9248 |
|
681 |
676 |
$79K |
| D1351 |
Sealant - per tooth |
2,627 |
804 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,971 |
1,964 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,814 |
1,807 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
584 |
581 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
963 |
938 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
738 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
58 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
182 |
178 |
$3K |
| D0603 |
|
10,319 |
10,251 |
$0.00 |
| D0602 |
|
1,552 |
1,541 |
$0.00 |