| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,561 |
6,508 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
12,307 |
12,208 |
$351K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,007 |
2,204 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,140 |
1,658 |
$304K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,064 |
2,038 |
$285K |
| D1351 |
Sealant - per tooth |
9,612 |
2,538 |
$257K |
| D1120 |
Prophylaxis - child |
5,908 |
5,868 |
$213K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,481 |
12,384 |
$181K |
| D0274 |
Bitewings - four radiographic images |
5,243 |
5,202 |
$179K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,211 |
398 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
2,277 |
2,261 |
$155K |
| D9248 |
|
1,047 |
1,021 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,169 |
4,135 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,893 |
2,859 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
2,390 |
2,343 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,785 |
1,344 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
83 |
27 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
262 |
$5K |
| D2331 |
|
51 |
24 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
30 |
$3K |
| D2330 |
|
18 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$526.27 |
| D0603 |
|
14,759 |
14,622 |
$0.00 |