| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,916 |
1,879 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
6,183 |
6,034 |
$167K |
| D1120 |
Prophylaxis - child |
4,522 |
4,412 |
$153K |
| D1351 |
Sealant - per tooth |
6,087 |
1,181 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,202 |
5,793 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,430 |
675 |
$128K |
| D1110 |
Prophylaxis - adult |
2,280 |
2,236 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,448 |
873 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,734 |
2,686 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,072 |
5,928 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
6,676 |
6,484 |
$76K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
421 |
81 |
$58K |
| D0330 |
Panoramic radiographic image |
1,167 |
1,124 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,814 |
1,694 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,345 |
1,277 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,935 |
1,883 |
$30K |
| D9248 |
|
263 |
245 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
130 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
293 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
49 |
14 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
42 |
$3K |
| D0603 |
|
9,468 |
9,281 |
$0.01 |