| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,270 |
3,251 |
$461K |
| D1120 |
Prophylaxis - child |
9,749 |
9,694 |
$356K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,908 |
1,179 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
9,250 |
9,206 |
$265K |
| D1351 |
Sealant - per tooth |
9,146 |
1,625 |
$254K |
| D9248 |
|
1,298 |
1,200 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,788 |
3,791 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,095 |
10,040 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
1,318 |
1,307 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,921 |
2,911 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,873 |
1,865 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
425 |
238 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,547 |
4,499 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,215 |
1,200 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
336 |
205 |
$26K |
| D1110 |
Prophylaxis - adult |
375 |
373 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
100 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
381 |
$7K |
| D2332 |
|
55 |
38 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
57 |
43 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
169 |
167 |
$5K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$956.70 |
| D9986 |
|
96 |
96 |
$0.00 |
| D0602 |
|
6,168 |
6,128 |
$0.00 |
| D0603 |
|
7,528 |
7,488 |
$0.00 |