| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,952 |
2,897 |
$384K |
| D1351 |
Sealant - per tooth |
13,243 |
2,258 |
$322K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,435 |
457 |
$321K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,836 |
1,129 |
$270K |
| D1120 |
Prophylaxis - child |
6,046 |
5,896 |
$206K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,260 |
6,031 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,288 |
5,127 |
$143K |
| D1110 |
Prophylaxis - adult |
2,096 |
2,031 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,691 |
7,481 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,956 |
2,885 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,915 |
6,585 |
$77K |
| D9248 |
|
573 |
533 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,108 |
2,016 |
$60K |
| D0330 |
Panoramic radiographic image |
1,607 |
1,562 |
$54K |
| D2335 |
|
276 |
107 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
571 |
347 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,842 |
2,790 |
$38K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
458 |
162 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
510 |
510 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,046 |
987 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
49 |
15 |
$13K |
| D1206 |
Topical application of fluoride varnish |
501 |
497 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
334 |
322 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
20 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$2K |
| D0160 |
|
13 |
13 |
$194.35 |
| D0603 |
|
11,430 |
11,160 |
$0.19 |