| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,889 |
1,791 |
$247K |
| D1120 |
Prophylaxis - child |
4,790 |
4,481 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,315 |
756 |
$156K |
| D1351 |
Sealant - per tooth |
5,835 |
1,313 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,795 |
4,476 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,186 |
5,770 |
$83K |
| D1110 |
Prophylaxis - adult |
1,522 |
1,415 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,129 |
2,955 |
$68K |
| D9248 |
|
539 |
503 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
814 |
752 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,372 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,379 |
1,173 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,248 |
2,085 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
193 |
50 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
241 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
930 |
885 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
86 |
24 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
27 |
$4K |
| D9420 |
|
71 |
63 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
37 |
$973.88 |
| D0603 |
|
3,131 |
3,007 |
$0.00 |
| D0602 |
|
4,844 |
4,626 |
$0.00 |
| D1999 |
|
389 |
333 |
$0.00 |