| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,709 |
5,654 |
$794K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,508 |
1,588 |
$501K |
| D1120 |
Prophylaxis - child |
13,097 |
13,010 |
$465K |
| D1351 |
Sealant - per tooth |
14,545 |
3,223 |
$396K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,880 |
1,757 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
11,516 |
11,460 |
$325K |
| D9248 |
|
2,497 |
2,413 |
$285K |
| D0272 |
Bitewings - two radiographic images |
12,206 |
12,122 |
$261K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,432 |
14,334 |
$206K |
| D0220 |
Intraoral - periapical first radiographic image |
14,214 |
14,055 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,169 |
13,629 |
$142K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,514 |
904 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,029 |
2,992 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,226 |
686 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,436 |
870 |
$87K |
| D1110 |
Prophylaxis - adult |
1,439 |
1,432 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
777 |
777 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,487 |
1,480 |
$49K |
| D0330 |
Panoramic radiographic image |
1,874 |
1,852 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,662 |
1,647 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
840 |
822 |
$22K |
| D1510 |
|
15 |
12 |
$2K |
| D0603 |
|
20,201 |
20,063 |
$0.00 |