| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,319 |
5,275 |
$734K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,554 |
1,303 |
$499K |
| D1120 |
Prophylaxis - child |
14,268 |
14,040 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
16,356 |
16,144 |
$452K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,868 |
17,598 |
$248K |
| D1351 |
Sealant - per tooth |
8,485 |
1,732 |
$220K |
| D1110 |
Prophylaxis - adult |
3,452 |
3,406 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,867 |
5,901 |
$176K |
| D0350 |
|
13,940 |
13,001 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,260 |
894 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,580 |
985 |
$117K |
| D0272 |
Bitewings - two radiographic images |
5,625 |
5,550 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,484 |
7,224 |
$80K |
| D9248 |
|
686 |
650 |
$76K |
| D0330 |
Panoramic radiographic image |
2,154 |
2,112 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,169 |
1,152 |
$64K |
| D2934 |
|
439 |
141 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,828 |
1,724 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,879 |
1,855 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,815 |
1,707 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
677 |
406 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
397 |
203 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,017 |
984 |
$18K |
| D0270 |
|
574 |
565 |
$3K |
| D0603 |
|
23,549 |
23,228 |
$0.00 |
| D0601 |
|
204 |
200 |
$0.00 |