| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,759 |
2,708 |
$378K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,087 |
634 |
$281K |
| D1120 |
Prophylaxis - child |
7,767 |
7,586 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,286 |
1,940 |
$263K |
| D1351 |
Sealant - per tooth |
9,486 |
2,625 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
8,431 |
8,228 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,247 |
10,006 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,483 |
910 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
10,904 |
10,598 |
$123K |
| D0272 |
Bitewings - two radiographic images |
5,472 |
5,325 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,547 |
9,875 |
$114K |
| D1110 |
Prophylaxis - adult |
2,005 |
1,960 |
$105K |
| D9248 |
|
820 |
776 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,753 |
2,690 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,112 |
1,963 |
$55K |
| D0350 |
|
4,880 |
4,580 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,489 |
1,460 |
$49K |
| D0330 |
Panoramic radiographic image |
743 |
732 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
125 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
24 |
$2K |
| D0170 |
|
194 |
183 |
$2K |
| D0270 |
|
258 |
249 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$262.92 |
| D1330 |
|
13 |
13 |
$61.25 |
| D0603 |
|
13,484 |
13,239 |
$0.00 |