| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,247 |
4,157 |
$580K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,014 |
1,151 |
$412K |
| D1120 |
Prophylaxis - child |
10,364 |
10,103 |
$359K |
| D1351 |
Sealant - per tooth |
12,723 |
3,028 |
$334K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,058 |
1,838 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
8,809 |
8,581 |
$240K |
| D1206 |
Topical application of fluoride varnish |
11,398 |
11,111 |
$158K |
| D0272 |
Bitewings - two radiographic images |
6,045 |
5,887 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,345 |
3,236 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,334 |
5,566 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,225 |
836 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
6,811 |
6,587 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,947 |
2,849 |
$74K |
| D1110 |
Prophylaxis - adult |
1,374 |
1,338 |
$70K |
| D0330 |
Panoramic radiographic image |
1,221 |
1,194 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,352 |
1,314 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
524 |
372 |
$29K |
| D9248 |
|
177 |
174 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,044 |
1,019 |
$18K |
| D1354 |
|
1,274 |
398 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
116 |
80 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
229 |
225 |
$3K |
| D1999 |
|
20 |
12 |
$0.00 |
| D0603 |
|
13,748 |
13,439 |
$0.00 |
| D0602 |
|
3,440 |
3,391 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |