| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9248 |
|
1,260 |
1,198 |
$332K |
| D0120 |
Periodic oral evaluation - established patient |
7,955 |
7,914 |
$284K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,741 |
818 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,266 |
1,129 |
$266K |
| D1120 |
Prophylaxis - child |
6,273 |
6,252 |
$262K |
| D1206 |
Topical application of fluoride varnish |
9,121 |
9,032 |
$254K |
| D1351 |
Sealant - per tooth |
6,900 |
1,422 |
$240K |
| D1110 |
Prophylaxis - adult |
2,832 |
2,812 |
$169K |
| D8670 |
Periodic orthodontic treatment visit |
496 |
443 |
$153K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,130 |
650 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,335 |
1,287 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
573 |
376 |
$82K |
| D1330 |
|
7,359 |
7,324 |
$81K |
| D1310 |
|
7,482 |
7,447 |
$81K |
| D0272 |
Bitewings - two radiographic images |
2,569 |
2,562 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,651 |
1,640 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
690 |
494 |
$64K |
| D1320 |
|
3,053 |
3,051 |
$59K |
| D0330 |
Panoramic radiographic image |
883 |
881 |
$56K |
| D2390 |
|
300 |
164 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
596 |
593 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
722 |
722 |
$31K |
| D2332 |
|
229 |
159 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
1,247 |
$18K |
| D1510 |
|
80 |
65 |
$16K |
| D2330 |
|
127 |
94 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
488 |
488 |
$10K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
43 |
14 |
$7K |
| D9110 |
|
114 |
112 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
280 |
$6K |
| D0340 |
|
124 |
121 |
$2K |
| D9222 |
|
14 |
14 |
$2K |
| D0270 |
|
63 |
62 |
$1K |
| D0603 |
|
135 |
134 |
$0.00 |