| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,524 |
2,461 |
$344K |
| D1351 |
Sealant - per tooth |
12,648 |
2,301 |
$334K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,929 |
1,325 |
$263K |
| D1120 |
Prophylaxis - child |
6,953 |
6,866 |
$245K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,681 |
673 |
$223K |
| D9248 |
|
1,814 |
1,732 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
6,122 |
6,041 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,208 |
5,004 |
$160K |
| D1206 |
Topical application of fluoride varnish |
7,642 |
7,532 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,425 |
758 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,075 |
644 |
$73K |
| D1110 |
Prophylaxis - adult |
1,288 |
1,267 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,829 |
5,620 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,788 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
795 |
328 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,100 |
2,073 |
$47K |
| D0330 |
Panoramic radiographic image |
669 |
658 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,454 |
1,409 |
$25K |
| D0274 |
Bitewings - four radiographic images |
740 |
726 |
$24K |
| D1330 |
|
2,289 |
2,220 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
825 |
800 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
289 |
286 |
$4K |
| D0603 |
|
10,635 |
10,456 |
$0.00 |
| D0602 |
|
53 |
52 |
$0.00 |
| D0601 |
|
28 |
28 |
$0.00 |