| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,113 |
5,082 |
$710K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,045 |
1,901 |
$575K |
| D1120 |
Prophylaxis - child |
15,611 |
15,514 |
$546K |
| D0120 |
Periodic oral evaluation - established patient |
16,917 |
16,813 |
$467K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,949 |
2,448 |
$458K |
| D1351 |
Sealant - per tooth |
16,844 |
2,907 |
$442K |
| D9248 |
|
3,154 |
2,970 |
$343K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,239 |
1,869 |
$339K |
| D1206 |
Topical application of fluoride varnish |
20,273 |
20,143 |
$285K |
| D1110 |
Prophylaxis - adult |
5,422 |
5,380 |
$284K |
| D0272 |
Bitewings - two radiographic images |
10,592 |
10,501 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,804 |
1,353 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,966 |
4,908 |
$164K |
| D0330 |
Panoramic radiographic image |
3,537 |
3,502 |
$116K |
| D0274 |
Bitewings - four radiographic images |
3,484 |
3,453 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,552 |
936 |
$88K |
| D0240 |
|
10,750 |
5,840 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
992 |
992 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,639 |
1,532 |
$42K |
| D2934 |
|
277 |
98 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,988 |
1,950 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,189 |
3,069 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,990 |
1,069 |
$19K |
| D7111 |
|
1,031 |
662 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
685 |
674 |
$10K |
| D9420 |
|
157 |
157 |
$6K |
| D2332 |
|
18 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D0270 |
|
128 |
128 |
$570.68 |
| D0603 |
|
27,193 |
26,980 |
$0.00 |
| D3120 |
|
13 |
12 |
$0.00 |