| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
6,778 |
6,741 |
$935K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,731 |
1,852 |
$638K |
| D1120 |
Prophylaxis - child |
15,507 |
15,356 |
$540K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,384 |
4,068 |
$514K |
| D0120 |
Periodic oral evaluation - established patient |
16,546 |
16,403 |
$460K |
| D1351 |
Sealant - per tooth |
12,868 |
3,651 |
$339K |
| D1206 |
Topical application of fluoride varnish |
20,957 |
20,753 |
$294K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,872 |
3,093 |
$288K |
| D1110 |
Prophylaxis - adult |
5,071 |
5,018 |
$265K |
| D0272 |
Bitewings - two radiographic images |
11,618 |
11,491 |
$240K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,720 |
7,882 |
$229K |
| D0274 |
Bitewings - four radiographic images |
6,318 |
6,252 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,294 |
8,388 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,477 |
4,424 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
11,129 |
10,752 |
$124K |
| D0330 |
Panoramic radiographic image |
2,686 |
2,663 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,202 |
1,200 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
672 |
417 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,414 |
1,389 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
329 |
199 |
$26K |
| D2934 |
|
65 |
25 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
49 |
$5K |
| D1510 |
|
31 |
26 |
$4K |
| D9430 |
|
99 |
97 |
$869.73 |
| D9420 |
|
21 |
17 |
$580.96 |
| D3120 |
|
749 |
609 |
$544.73 |
| D0603 |
|
28,881 |
28,533 |
$0.00 |