| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,257 |
2,240 |
$313K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,996 |
657 |
$287K |
| D1120 |
Prophylaxis - child |
7,964 |
7,922 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
10,048 |
9,994 |
$283K |
| D1351 |
Sealant - per tooth |
10,317 |
1,801 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,249 |
1,304 |
$220K |
| D1110 |
Prophylaxis - adult |
3,622 |
3,600 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,505 |
1,491 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,833 |
9,775 |
$141K |
| D0274 |
Bitewings - four radiographic images |
4,397 |
4,365 |
$141K |
| D0272 |
Bitewings - two radiographic images |
5,388 |
5,356 |
$117K |
| D9248 |
|
951 |
922 |
$111K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,043 |
1,995 |
$53K |
| D0330 |
Panoramic radiographic image |
1,634 |
1,626 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,446 |
1,432 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,890 |
3,840 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,481 |
3,063 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,575 |
1,570 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
238 |
236 |
$16K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
181 |
70 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
203 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
29 |
$3K |
| D1330 |
|
59 |
54 |
$648.03 |
| D7111 |
|
15 |
12 |
$172.05 |
| D0270 |
|
29 |
29 |
$142.10 |
| D0603 |
|
14,066 |
13,979 |
$0.00 |