| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,574 |
3,555 |
$494K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,116 |
1,687 |
$303K |
| D1120 |
Prophylaxis - child |
8,115 |
8,041 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
9,082 |
8,992 |
$254K |
| D1351 |
Sealant - per tooth |
9,464 |
2,030 |
$249K |
| D1110 |
Prophylaxis - adult |
3,573 |
3,532 |
$189K |
| D1206 |
Topical application of fluoride varnish |
11,773 |
11,659 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,062 |
8,871 |
$155K |
| D0274 |
Bitewings - four radiographic images |
4,557 |
4,501 |
$142K |
| D0272 |
Bitewings - two radiographic images |
5,974 |
5,920 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
10,560 |
10,300 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,062 |
3,011 |
$101K |
| D9248 |
|
884 |
857 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,248 |
870 |
$94K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
637 |
285 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,970 |
1,880 |
$51K |
| D0330 |
Panoramic radiographic image |
1,444 |
1,429 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
478 |
477 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
120 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
482 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
40 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$1K |
| D1354 |
|
59 |
28 |
$661.68 |
| D0603 |
|
16,028 |
15,894 |
$0.00 |
| D3120 |
|
17 |
12 |
$0.00 |