| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,233 |
3,206 |
$452K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,331 |
1,911 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
10,648 |
10,564 |
$304K |
| D1120 |
Prophylaxis - child |
7,650 |
7,590 |
$273K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,971 |
8,875 |
$254K |
| D1351 |
Sealant - per tooth |
8,668 |
2,791 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,884 |
1,709 |
$220K |
| D1110 |
Prophylaxis - adult |
3,268 |
3,246 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,326 |
11,241 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,057 |
2,043 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
9,439 |
9,334 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,229 |
3,199 |
$109K |
| D7240 |
Removal of impacted tooth - completely bony |
362 |
106 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
637 |
165 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,590 |
3,521 |
$91K |
| D0272 |
Bitewings - two radiographic images |
3,694 |
3,669 |
$84K |
| D0350 |
|
3,867 |
3,802 |
$52K |
| D9248 |
|
397 |
391 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
425 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
146 |
57 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
178 |
$3K |
| D0170 |
|
20 |
20 |
$148.86 |
| D0603 |
|
15,287 |
15,184 |
$0.00 |