| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,193 |
3,125 |
$425K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,814 |
1,214 |
$341K |
| D1351 |
Sealant - per tooth |
12,003 |
1,586 |
$286K |
| D1120 |
Prophylaxis - child |
6,645 |
6,377 |
$220K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,542 |
338 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
7,594 |
7,264 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,940 |
7,877 |
$160K |
| D1110 |
Prophylaxis - adult |
2,716 |
2,566 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,494 |
9,050 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
9,068 |
8,454 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,134 |
506 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,753 |
2,604 |
$80K |
| D0272 |
Bitewings - two radiographic images |
4,285 |
4,104 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,239 |
2,078 |
$67K |
| D0330 |
Panoramic radiographic image |
1,493 |
1,397 |
$39K |
| D9248 |
|
316 |
294 |
$32K |
| D7240 |
Removal of impacted tooth - completely bony |
114 |
38 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
456 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
90 |
38 |
$7K |
| D2335 |
|
50 |
15 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
185 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
275 |
$5K |
| D9222 |
|
60 |
55 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
61 |
40 |
$2K |
| D4341 |
|
165 |
25 |
$1K |
| D9610 |
|
28 |
26 |
$358.38 |
| D9310 |
|
12 |
12 |
$192.48 |
| D0160 |
|
12 |
12 |
$176.42 |
| D4355 |
|
13 |
12 |
$71.66 |
| D0603 |
|
13,097 |
12,853 |
$0.00 |