| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,377 |
4,209 |
$592K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,944 |
1,171 |
$558K |
| D0120 |
Periodic oral evaluation - established patient |
20,005 |
19,226 |
$549K |
| D1351 |
Sealant - per tooth |
18,344 |
4,601 |
$478K |
| D1120 |
Prophylaxis - child |
13,113 |
12,633 |
$457K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,466 |
2,434 |
$424K |
| D1110 |
Prophylaxis - adult |
7,647 |
7,359 |
$399K |
| D0272 |
Bitewings - two radiographic images |
14,331 |
13,799 |
$297K |
| D1206 |
Topical application of fluoride varnish |
20,667 |
19,931 |
$290K |
| D9248 |
|
2,177 |
2,121 |
$247K |
| D0220 |
Intraoral - periapical first radiographic image |
20,162 |
19,405 |
$240K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,188 |
1,797 |
$234K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,789 |
18,409 |
$221K |
| D0274 |
Bitewings - four radiographic images |
5,974 |
5,798 |
$199K |
| D7230 |
|
644 |
220 |
$105K |
| D0330 |
Panoramic radiographic image |
2,409 |
2,319 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
407 |
272 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
549 |
336 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
953 |
918 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
303 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,158 |
1,115 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
275 |
$9K |
| D7220 |
|
62 |
25 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
41 |
$6K |
| D2934 |
|
34 |
12 |
$5K |
| D7111 |
|
121 |
75 |
$1K |
| D1330 |
|
44 |
42 |
$491.50 |
| D0603 |
|
7,693 |
7,402 |
$0.02 |
| D0601 |
|
10,948 |
10,511 |
$0.00 |
| D0602 |
|
8,192 |
7,945 |
$0.00 |