| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,719 |
1,706 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,492 |
1,267 |
$225K |
| D1120 |
Prophylaxis - child |
6,207 |
6,049 |
$213K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,480 |
712 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
6,514 |
6,355 |
$176K |
| D1351 |
Sealant - per tooth |
6,999 |
1,530 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,721 |
6,864 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,397 |
874 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,232 |
7,052 |
$100K |
| D0272 |
Bitewings - two radiographic images |
4,334 |
4,235 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
8,684 |
7,685 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,195 |
1,169 |
$66K |
| D1110 |
Prophylaxis - adult |
1,085 |
1,054 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,455 |
2,290 |
$42K |
| D9248 |
|
970 |
889 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
957 |
544 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,264 |
1,227 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
897 |
866 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
862 |
839 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
134 |
66 |
$10K |
| D0330 |
Panoramic radiographic image |
287 |
284 |
$2K |
| D0270 |
|
54 |
53 |
$205.80 |
| D1999 |
|
180 |
173 |
$0.00 |
| D0603 |
|
10,081 |
9,735 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |