| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,680 |
2,669 |
$377K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,821 |
6,691 |
$374K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,149 |
1,393 |
$309K |
| D1351 |
Sealant - per tooth |
9,950 |
2,180 |
$274K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,681 |
746 |
$247K |
| D1120 |
Prophylaxis - child |
5,587 |
5,562 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
5,325 |
5,303 |
$152K |
| D9248 |
|
1,108 |
976 |
$132K |
| D2335 |
|
690 |
277 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,259 |
614 |
$95K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,092 |
500 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
7,322 |
7,252 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,109 |
1,962 |
$56K |
| D1110 |
Prophylaxis - adult |
919 |
915 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,436 |
3,418 |
$50K |
| D1206 |
Topical application of fluoride varnish |
3,087 |
3,079 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,241 |
1,230 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
312 |
205 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
846 |
832 |
$15K |
| D7111 |
|
18 |
13 |
$172.05 |
| D0602 |
|
188 |
188 |
$0.00 |
| D0603 |
|
8,842 |
8,783 |
$0.00 |
| D0601 |
|
17 |
17 |
$0.00 |