| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,733 |
4,551 |
$634K |
| D0120 |
Periodic oral evaluation - established patient |
23,246 |
22,510 |
$626K |
| D1351 |
Sealant - per tooth |
22,530 |
5,735 |
$581K |
| D1120 |
Prophylaxis - child |
15,175 |
14,661 |
$516K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,876 |
1,591 |
$509K |
| D1110 |
Prophylaxis - adult |
8,939 |
8,651 |
$457K |
| D1206 |
Topical application of fluoride varnish |
24,083 |
23,289 |
$332K |
| D9248 |
|
2,423 |
2,314 |
$257K |
| D0272 |
Bitewings - two radiographic images |
12,761 |
12,273 |
$246K |
| D0274 |
Bitewings - four radiographic images |
7,999 |
7,738 |
$236K |
| D0220 |
Intraoral - periapical first radiographic image |
21,062 |
20,225 |
$228K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,422 |
18,940 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,186 |
778 |
$85K |
| D0330 |
Panoramic radiographic image |
3,060 |
2,921 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
911 |
910 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,292 |
2,198 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
576 |
370 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
237 |
$23K |
| D2140 |
|
459 |
318 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
423 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
535 |
511 |
$9K |
| D0270 |
|
672 |
649 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D7111 |
|
144 |
89 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$1K |
| D0603 |
|
30,035 |
29,007 |
$0.08 |
| D1330 |
|
37 |
37 |
$0.02 |
| D1310 |
|
37 |
37 |
$0.00 |