| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,520 |
1,492 |
$209K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,288 |
364 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,051 |
494 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,924 |
2,208 |
$75K |
| D1120 |
Prophylaxis - child |
1,689 |
1,653 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
728 |
386 |
$56K |
| D1351 |
Sealant - per tooth |
1,923 |
444 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,145 |
1,100 |
$38K |
| D9248 |
|
278 |
270 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,365 |
2,307 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,893 |
1,850 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
866 |
860 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
786 |
724 |
$20K |
| D1110 |
Prophylaxis - adult |
327 |
320 |
$17K |
| D0274 |
Bitewings - four radiographic images |
559 |
533 |
$16K |
| D0272 |
Bitewings - two radiographic images |
718 |
705 |
$15K |
| D0350 |
|
568 |
537 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
82 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
64 |
27 |
$5K |
| D0160 |
|
265 |
260 |
$4K |
| D0330 |
Panoramic radiographic image |
74 |
71 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
97 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
60 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$917.42 |
| D0603 |
|
3,648 |
3,568 |
$0.00 |