| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,469 |
3,303 |
$463K |
| D1120 |
Prophylaxis - child |
10,036 |
9,550 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
12,601 |
11,970 |
$340K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,374 |
1,189 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,498 |
1,858 |
$227K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,603 |
1,860 |
$187K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,242 |
12,577 |
$183K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,774 |
7,328 |
$161K |
| D1110 |
Prophylaxis - adult |
2,970 |
2,801 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,597 |
5,207 |
$137K |
| D0272 |
Bitewings - two radiographic images |
5,773 |
5,505 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
8,945 |
8,467 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,458 |
2,312 |
$77K |
| D0330 |
Panoramic radiographic image |
1,102 |
1,036 |
$59K |
| D1351 |
Sealant - per tooth |
1,718 |
703 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
813 |
441 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
182 |
109 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
326 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
479 |
452 |
$8K |
| D0270 |
|
1,157 |
1,100 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$777.04 |
| D1354 |
|
78 |
12 |
$635.40 |
| D0603 |
|
17,067 |
16,290 |
$0.00 |
| D9986 |
|
94 |
90 |
$0.00 |