| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
8,214 |
8,106 |
$1.13M |
| D1351 |
Sealant - per tooth |
37,215 |
7,011 |
$942K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,610 |
3,453 |
$901K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,657 |
1,002 |
$633K |
| D1120 |
Prophylaxis - child |
15,505 |
15,219 |
$533K |
| D0120 |
Periodic oral evaluation - established patient |
16,913 |
16,569 |
$459K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,619 |
16,979 |
$354K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,868 |
19,489 |
$275K |
| D1110 |
Prophylaxis - adult |
4,899 |
4,800 |
$251K |
| D0220 |
Intraoral - periapical first radiographic image |
18,554 |
18,039 |
$215K |
| D0274 |
Bitewings - four radiographic images |
6,606 |
6,462 |
$211K |
| D9248 |
|
1,360 |
1,302 |
$150K |
| D0272 |
Bitewings - two radiographic images |
8,425 |
8,274 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,564 |
3,491 |
$117K |
| D0330 |
Panoramic radiographic image |
2,675 |
2,624 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,131 |
3,004 |
$81K |
| D2332 |
|
509 |
177 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
785 |
299 |
$61K |
| D2331 |
|
565 |
226 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
649 |
649 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
169 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
177 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
904 |
878 |
$15K |
| D2335 |
|
29 |
12 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$960.90 |
| D1206 |
Topical application of fluoride varnish |
55 |
54 |
$761.46 |
| D0603 |
|
28,725 |
28,255 |
$0.00 |