| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,079 |
4,031 |
$557K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,232 |
983 |
$451K |
| D1120 |
Prophylaxis - child |
8,310 |
8,152 |
$283K |
| D1351 |
Sealant - per tooth |
9,122 |
1,671 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
6,785 |
6,671 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,753 |
860 |
$166K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,362 |
6,379 |
$150K |
| D1206 |
Topical application of fluoride varnish |
9,682 |
9,514 |
$133K |
| D0272 |
Bitewings - two radiographic images |
5,569 |
5,467 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,225 |
3,146 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,276 |
658 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,245 |
7,026 |
$83K |
| D1110 |
Prophylaxis - adult |
1,353 |
1,332 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,761 |
1,733 |
$54K |
| D9248 |
|
361 |
357 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,195 |
1,151 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
437 |
437 |
$27K |
| D0330 |
Panoramic radiographic image |
986 |
972 |
$25K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
177 |
96 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
146 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
371 |
$7K |
| D0603 |
|
14,762 |
14,446 |
$0.00 |