| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,526 |
2,477 |
$344K |
| D1120 |
Prophylaxis - child |
5,392 |
5,213 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
6,229 |
6,046 |
$171K |
| D1351 |
Sealant - per tooth |
6,921 |
1,027 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,284 |
6,876 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,234 |
537 |
$118K |
| D1110 |
Prophylaxis - adult |
2,076 |
2,022 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,250 |
7,025 |
$100K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
698 |
151 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,146 |
3,055 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
7,697 |
7,426 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,768 |
1,684 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,882 |
2,792 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
651 |
335 |
$48K |
| D9248 |
|
365 |
342 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
531 |
524 |
$34K |
| D0330 |
Panoramic radiographic image |
1,330 |
1,279 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
308 |
300 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
36 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
98 |
$3K |
| D0270 |
|
71 |
71 |
$272.93 |
| D1330 |
|
125 |
123 |
$47.78 |
| D0603 |
|
10,551 |
10,297 |
$0.00 |