| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,646 |
1,631 |
$187K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,459 |
6,208 |
$176K |
| D1351 |
Sealant - per tooth |
8,229 |
1,687 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
5,917 |
5,776 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,975 |
899 |
$136K |
| D1120 |
Prophylaxis - child |
4,402 |
4,299 |
$122K |
| D0274 |
Bitewings - four radiographic images |
2,945 |
2,887 |
$80K |
| D1110 |
Prophylaxis - adult |
1,807 |
1,772 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,306 |
713 |
$77K |
| D1206 |
Topical application of fluoride varnish |
6,404 |
6,266 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
6,709 |
6,513 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
804 |
730 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
402 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
76 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
96 |
95 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$383.11 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$205.80 |
| D7111 |
|
17 |
12 |
$194.99 |
| D0603 |
|
4,210 |
4,140 |
$0.01 |
| D0602 |
|
2,114 |
2,085 |
$0.01 |
| D0601 |
|
1,552 |
1,511 |
$0.00 |