| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
858 |
803 |
$112K |
| D1120 |
Prophylaxis - child |
2,679 |
2,558 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,951 |
2,828 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
387 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,370 |
2,282 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
355 |
155 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,550 |
2,728 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,290 |
3,152 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,077 |
2,911 |
$36K |
| D1351 |
Sealant - per tooth |
1,287 |
325 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
784 |
685 |
$19K |
| D1110 |
Prophylaxis - adult |
331 |
324 |
$18K |
| D0330 |
Panoramic radiographic image |
154 |
147 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
180 |
173 |
$6K |
| D0603 |
|
4,668 |
4,445 |
$0.00 |