| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
7,244 |
7,205 |
$1.01M |
| D1351 |
Sealant - per tooth |
30,493 |
6,267 |
$837K |
| D0120 |
Periodic oral evaluation - established patient |
21,318 |
21,238 |
$606K |
| D1120 |
Prophylaxis - child |
16,028 |
15,969 |
$581K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,137 |
21,393 |
$447K |
| D1110 |
Prophylaxis - adult |
7,282 |
7,238 |
$390K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,803 |
1,670 |
$384K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,598 |
23,489 |
$342K |
| D0274 |
Bitewings - four radiographic images |
9,072 |
9,024 |
$305K |
| D0220 |
Intraoral - periapical first radiographic image |
22,657 |
22,467 |
$260K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,335 |
247 |
$195K |
| D0210 |
Intraoral - complete series of radiographic images |
2,201 |
2,197 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,698 |
6,665 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,410 |
563 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,436 |
1,413 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,287 |
1,171 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
392 |
104 |
$32K |
| D0330 |
Panoramic radiographic image |
916 |
914 |
$24K |
| D2335 |
|
142 |
39 |
$21K |
| D2330 |
|
246 |
103 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
36 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
298 |
$5K |
| D2332 |
|
28 |
14 |
$4K |
| D0603 |
|
31,161 |
31,008 |
$0.00 |