| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,501 |
4,473 |
$626K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,911 |
1,679 |
$378K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,958 |
7,679 |
$355K |
| D1120 |
Prophylaxis - child |
6,713 |
6,623 |
$237K |
| D1351 |
Sealant - per tooth |
8,120 |
1,822 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
5,978 |
5,917 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,079 |
7,967 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
8,304 |
8,134 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,061 |
2,009 |
$68K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
459 |
136 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,881 |
2,849 |
$65K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,198 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,028 |
1,899 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
205 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
301 |
290 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
178 |
47 |
$14K |
| D9248 |
|
72 |
69 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
58 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
249 |
$4K |
| D1330 |
|
372 |
370 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$1K |
| D0603 |
|
12,685 |
12,560 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |