| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,291 |
4,207 |
$589K |
| D1351 |
Sealant - per tooth |
16,689 |
3,788 |
$430K |
| D1120 |
Prophylaxis - child |
12,209 |
11,865 |
$421K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,236 |
2,631 |
$399K |
| D0120 |
Periodic oral evaluation - established patient |
13,603 |
13,236 |
$372K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,550 |
844 |
$344K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,327 |
2,592 |
$317K |
| D1110 |
Prophylaxis - adult |
4,680 |
4,531 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,795 |
16,317 |
$234K |
| D0272 |
Bitewings - two radiographic images |
9,393 |
9,110 |
$208K |
| D0210 |
Intraoral - complete series of radiographic images |
2,404 |
2,307 |
$154K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,821 |
5,275 |
$149K |
| D0274 |
Bitewings - four radiographic images |
3,667 |
3,564 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,210 |
2,961 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
7,572 |
7,198 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,447 |
5,280 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
523 |
259 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
190 |
89 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
504 |
491 |
$9K |
| D0350 |
|
387 |
366 |
$5K |
| D9420 |
|
95 |
94 |
$3K |
| D9248 |
|
13 |
13 |
$2K |
| D7111 |
|
25 |
13 |
$286.75 |
| D0603 |
|
21,257 |
20,715 |
$0.00 |