| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,067 |
3,042 |
$425K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,698 |
632 |
$377K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,508 |
1,082 |
$250K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,059 |
5,828 |
$248K |
| D1120 |
Prophylaxis - child |
4,881 |
4,848 |
$174K |
| D1351 |
Sealant - per tooth |
4,661 |
1,167 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,175 |
3,157 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,357 |
2,334 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,519 |
6,429 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,822 |
3,797 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,253 |
1,249 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
335 |
$42K |
| D9248 |
|
352 |
347 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
387 |
139 |
$31K |
| D1110 |
Prophylaxis - adult |
486 |
484 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,634 |
1,624 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
827 |
798 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,133 |
1,119 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
189 |
$19K |
| D2934 |
|
33 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$607.88 |
| D0240 |
|
44 |
44 |
$240.21 |
| D0250 |
|
13 |
13 |
$147.04 |
| D1330 |
|
165 |
164 |
$12.25 |
| D0603 |
|
4,101 |
4,080 |
$0.17 |
| D0602 |
|
2,668 |
2,655 |
$0.00 |
| D0601 |
|
1,674 |
1,672 |
$0.00 |