| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
13,286 |
12,950 |
$1.82M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
9,534 |
2,816 |
$1.31M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,220 |
5,584 |
$1.06M |
| D0230 |
Intraoral - periapical each additional radiographic image |
92,660 |
28,469 |
$965K |
| D1120 |
Prophylaxis - child |
23,605 |
23,225 |
$832K |
| D0120 |
Periodic oral evaluation - established patient |
26,436 |
26,051 |
$738K |
| D1351 |
Sealant - per tooth |
22,436 |
5,261 |
$607K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,603 |
4,184 |
$565K |
| D1206 |
Topical application of fluoride varnish |
28,279 |
27,855 |
$401K |
| D0220 |
Intraoral - periapical first radiographic image |
30,694 |
30,077 |
$349K |
| D1110 |
Prophylaxis - adult |
6,155 |
6,078 |
$328K |
| D0274 |
Bitewings - four radiographic images |
10,682 |
10,514 |
$310K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,142 |
9,800 |
$263K |
| D9248 |
|
1,313 |
1,294 |
$148K |
| D0272 |
Bitewings - two radiographic images |
6,494 |
6,374 |
$134K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,603 |
657 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,354 |
1,152 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,201 |
3,118 |
$107K |
| D7240 |
Removal of impacted tooth - completely bony |
303 |
100 |
$80K |
| D0350 |
|
7,478 |
7,296 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,272 |
1,270 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
2,032 |
1,973 |
$36K |
| D2330 |
|
463 |
169 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
211 |
150 |
$22K |
| D0330 |
Panoramic radiographic image |
2,525 |
2,458 |
$22K |
| D1330 |
|
1,488 |
1,462 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
848 |
834 |
$12K |
| D2934 |
|
67 |
26 |
$10K |
| D0160 |
|
123 |
123 |
$2K |
| D7111 |
|
61 |
40 |
$665.26 |
| D9420 |
|
15 |
14 |
$435.72 |
| D3110 |
|
20 |
14 |
$170.83 |
| D0270 |
|
30 |
29 |
$105.15 |
| D0603 |
|
43,910 |
43,087 |
$0.00 |
| D3120 |
|
38 |
27 |
$0.00 |
| D0601 |
|
19 |
19 |
$0.00 |
| D0602 |
|
44 |
44 |
$0.00 |