| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
30,206 |
6,492 |
$326K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,367 |
2,313 |
$322K |
| D1351 |
Sealant - per tooth |
11,486 |
2,208 |
$282K |
| D1120 |
Prophylaxis - child |
6,291 |
6,096 |
$216K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,154 |
361 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
5,239 |
5,084 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,538 |
766 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,234 |
6,984 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,090 |
6,801 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
876 |
464 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,183 |
2,075 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,291 |
1,997 |
$55K |
| D1110 |
Prophylaxis - adult |
836 |
798 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
476 |
447 |
$26K |
| D0272 |
Bitewings - two radiographic images |
603 |
577 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
167 |
$13K |
| D9248 |
|
76 |
71 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
310 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
38 |
13 |
$2K |
| D1330 |
|
224 |
204 |
$2K |
| D0603 |
|
10,267 |
9,843 |
$0.00 |