| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,539 |
1,399 |
$192K |
| D1351 |
Sealant - per tooth |
8,214 |
1,547 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,878 |
806 |
$154K |
| D1120 |
Prophylaxis - child |
3,059 |
2,705 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,630 |
3,200 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,393 |
2,136 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
490 |
246 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
470 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,631 |
3,208 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,146 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,850 |
3,393 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,405 |
1,163 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,160 |
$25K |
| D1110 |
Prophylaxis - adult |
416 |
378 |
$20K |
| D0274 |
Bitewings - four radiographic images |
534 |
479 |
$15K |
| D0330 |
Panoramic radiographic image |
333 |
305 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
121 |
82 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
60 |
$4K |
| D1330 |
|
279 |
267 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
56 |
$955.90 |
| D0603 |
|
4,836 |
4,299 |
$0.59 |
| D0602 |
|
405 |
347 |
$0.00 |