| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,693 |
2,688 |
$379K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,667 |
2,218 |
$342K |
| D1351 |
Sealant - per tooth |
10,811 |
2,104 |
$298K |
| D1120 |
Prophylaxis - child |
7,124 |
7,098 |
$254K |
| D0120 |
Periodic oral evaluation - established patient |
8,955 |
8,905 |
$250K |
| D1110 |
Prophylaxis - adult |
3,515 |
3,486 |
$184K |
| D0274 |
Bitewings - four radiographic images |
5,501 |
5,461 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,445 |
10,395 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
11,848 |
11,605 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,766 |
1,221 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,461 |
10,643 |
$122K |
| D0272 |
Bitewings - two radiographic images |
4,681 |
4,661 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,569 |
3,387 |
$94K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
380 |
118 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
966 |
966 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
199 |
$26K |
| D0350 |
|
1,615 |
1,605 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
545 |
538 |
$10K |
| D9248 |
|
54 |
54 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
76 |
40 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
41 |
$5K |
| D9420 |
|
25 |
25 |
$899.38 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$216.09 |
| D0603 |
|
13,354 |
13,255 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |