| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
12,490 |
12,366 |
$1.74M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,321 |
2,826 |
$1.34M |
| D0120 |
Periodic oral evaluation - established patient |
46,857 |
46,531 |
$1.34M |
| D1120 |
Prophylaxis - child |
35,936 |
35,676 |
$1.30M |
| D1110 |
Prophylaxis - adult |
15,174 |
15,074 |
$817K |
| D1206 |
Topical application of fluoride varnish |
50,659 |
50,293 |
$734K |
| D0272 |
Bitewings - two radiographic images |
33,142 |
32,887 |
$730K |
| D0220 |
Intraoral - periapical first radiographic image |
56,024 |
55,513 |
$658K |
| D0230 |
Intraoral - periapical each additional radiographic image |
60,660 |
52,691 |
$654K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,255 |
3,563 |
$625K |
| D7240 |
Removal of impacted tooth - completely bony |
2,142 |
704 |
$601K |
| D9248 |
|
5,188 |
5,117 |
$599K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,309 |
4,330 |
$560K |
| D0274 |
Bitewings - four radiographic images |
15,373 |
15,272 |
$482K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,290 |
4,241 |
$146K |
| D2335 |
|
834 |
311 |
$124K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,532 |
4,447 |
$120K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,330 |
464 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,631 |
1,631 |
$108K |
| D0330 |
Panoramic radiographic image |
5,054 |
5,018 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,783 |
2,752 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
537 |
360 |
$28K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
171 |
57 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
647 |
640 |
$9K |
| D7230 |
|
36 |
24 |
$6K |
| D9222 |
|
57 |
57 |
$4K |
| D1351 |
Sealant - per tooth |
122 |
37 |
$3K |
| D7111 |
|
228 |
146 |
$3K |
| D9986 |
|
152 |
150 |
$0.00 |
| D9987 |
|
88 |
86 |
$0.00 |
| D0603 |
|
66,648 |
66,119 |
$0.00 |