| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,920 |
5,834 |
$817K |
| D1351 |
Sealant - per tooth |
23,219 |
4,606 |
$606K |
| D1120 |
Prophylaxis - child |
13,178 |
12,964 |
$470K |
| D0120 |
Periodic oral evaluation - established patient |
16,421 |
16,175 |
$462K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,176 |
16,619 |
$364K |
| D1110 |
Prophylaxis - adult |
5,304 |
5,229 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,703 |
18,409 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,561 |
891 |
$254K |
| D0274 |
Bitewings - four radiographic images |
6,560 |
6,479 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
17,824 |
17,440 |
$195K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
829 |
161 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,908 |
1,883 |
$120K |
| D0272 |
Bitewings - two radiographic images |
5,321 |
5,232 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
779 |
267 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,594 |
1,561 |
$53K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
375 |
102 |
$31K |
| D0330 |
Panoramic radiographic image |
884 |
855 |
$23K |
| D2330 |
|
153 |
56 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
409 |
361 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$955.90 |
| D0603 |
|
24,929 |
24,525 |
$0.00 |