| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,431 |
2,322 |
$318K |
| D1120 |
Prophylaxis - child |
7,045 |
6,604 |
$236K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,672 |
495 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
6,115 |
5,724 |
$161K |
| D0272 |
Bitewings - two radiographic images |
6,539 |
6,132 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
6,724 |
6,271 |
$77K |
| D1206 |
Topical application of fluoride varnish |
5,429 |
5,119 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,280 |
5,857 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,577 |
1,426 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
570 |
307 |
$33K |
| D0330 |
Panoramic radiographic image |
1,000 |
945 |
$27K |
| D1351 |
Sealant - per tooth |
998 |
246 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,755 |
1,696 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
336 |
336 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
400 |
386 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
55 |
$9K |
| D1330 |
|
682 |
663 |
$7K |
| D9248 |
|
54 |
47 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
257 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
35 |
33 |
$1K |
| D1999 |
|
113 |
109 |
$0.00 |
| D0603 |
|
3,960 |
3,840 |
$0.00 |
| D0602 |
|
1,493 |
1,457 |
$0.00 |
| D0601 |
|
4,542 |
4,415 |
$0.00 |