| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,081 |
4,040 |
$567K |
| D1120 |
Prophylaxis - child |
9,489 |
9,391 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
9,694 |
9,611 |
$272K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,915 |
617 |
$268K |
| D1351 |
Sealant - per tooth |
7,868 |
1,758 |
$207K |
| D1206 |
Topical application of fluoride varnish |
12,569 |
12,443 |
$177K |
| D1110 |
Prophylaxis - adult |
3,038 |
3,006 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,641 |
1,097 |
$158K |
| D0272 |
Bitewings - two radiographic images |
6,527 |
6,467 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,781 |
1,176 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,757 |
3,716 |
$117K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,121 |
6,008 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,015 |
2,975 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,389 |
7,190 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,448 |
2,365 |
$64K |
| D0330 |
Panoramic radiographic image |
1,810 |
1,800 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
438 |
438 |
$27K |
| D9248 |
|
137 |
135 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
561 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
110 |
52 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
70 |
$7K |
| D9420 |
|
14 |
13 |
$472.03 |
| D0603 |
|
17,557 |
17,302 |
$0.00 |