| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
9,546 |
9,461 |
$1.33M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,194 |
2,352 |
$1.16M |
| D1120 |
Prophylaxis - child |
31,123 |
30,897 |
$1.12M |
| D0120 |
Periodic oral evaluation - established patient |
37,844 |
37,595 |
$1.07M |
| D0272 |
Bitewings - two radiographic images |
28,348 |
28,163 |
$627K |
| D1206 |
Topical application of fluoride varnish |
40,850 |
40,575 |
$588K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,368 |
42,902 |
$582K |
| D1110 |
Prophylaxis - adult |
10,733 |
10,670 |
$574K |
| D0220 |
Intraoral - periapical first radiographic image |
45,822 |
45,433 |
$540K |
| D7240 |
Removal of impacted tooth - completely bony |
1,286 |
396 |
$357K |
| D0274 |
Bitewings - four radiographic images |
10,788 |
10,725 |
$339K |
| D9248 |
|
2,599 |
2,565 |
$296K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,398 |
2,143 |
$256K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,325 |
1,399 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,740 |
3,687 |
$126K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,221 |
3,145 |
$84K |
| D2335 |
|
408 |
175 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
492 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
453 |
214 |
$36K |
| D0330 |
Panoramic radiographic image |
2,553 |
2,535 |
$33K |
| D9239 |
|
515 |
510 |
$28K |
| D9243 |
|
671 |
447 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,323 |
1,309 |
$24K |
| D1351 |
Sealant - per tooth |
651 |
201 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
224 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
653 |
650 |
$9K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
79 |
24 |
$5K |
| D9610 |
|
206 |
201 |
$4K |
| D9222 |
|
24 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D7111 |
|
20 |
16 |
$229.40 |
| D9986 |
|
12 |
12 |
$0.00 |
| D0603 |
|
54,811 |
54,377 |
$0.00 |