| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,955 |
4,855 |
$672K |
| D1120 |
Prophylaxis - child |
12,358 |
12,064 |
$424K |
| D0120 |
Periodic oral evaluation - established patient |
12,260 |
12,014 |
$337K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,411 |
14,429 |
$252K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,197 |
14,840 |
$211K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,311 |
1,299 |
$207K |
| D1351 |
Sealant - per tooth |
7,044 |
1,364 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
15,721 |
15,258 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,432 |
4,325 |
$141K |
| D1110 |
Prophylaxis - adult |
2,602 |
2,547 |
$133K |
| D0272 |
Bitewings - two radiographic images |
6,516 |
6,380 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,868 |
2,752 |
$93K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
458 |
124 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
796 |
779 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,999 |
1,884 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
440 |
300 |
$32K |
| D0330 |
Panoramic radiographic image |
520 |
498 |
$13K |
| D9248 |
|
102 |
99 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
53 |
24 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
196 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
13 |
$1K |
| D0603 |
|
21,520 |
21,086 |
$0.00 |