| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,817 |
1,766 |
$230K |
| D1120 |
Prophylaxis - child |
2,432 |
2,352 |
$80K |
| D1351 |
Sealant - per tooth |
2,490 |
409 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,740 |
1,693 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,700 |
1,642 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,552 |
2,412 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
807 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,553 |
2,216 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,653 |
1,624 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
665 |
587 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
90 |
36 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
63 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
941 |
889 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
354 |
$7K |
| D0330 |
Panoramic radiographic image |
110 |
102 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
37 |
$5K |
| D0274 |
Bitewings - four radiographic images |
158 |
149 |
$4K |
| D1110 |
Prophylaxis - adult |
88 |
83 |
$4K |
| D0350 |
|
272 |
248 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
32 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D1330 |
|
111 |
108 |
$1K |
| D0603 |
|
4,712 |
4,540 |
$0.00 |