| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
970 |
948 |
$127K |
| D1120 |
Prophylaxis - child |
2,121 |
2,001 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,709 |
1,629 |
$45K |
| D1351 |
Sealant - per tooth |
2,075 |
328 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,583 |
1,478 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,439 |
2,311 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,521 |
2,323 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,761 |
2,155 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
137 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
767 |
$24K |
| D1110 |
Prophylaxis - adult |
225 |
222 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
81 |
19 |
$11K |
| D0274 |
Bitewings - four radiographic images |
327 |
321 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
504 |
461 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
229 |
207 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
29 |
$3K |
| D1330 |
|
170 |
161 |
$1K |
| D0330 |
Panoramic radiographic image |
41 |
39 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$735.00 |
| D9420 |
|
13 |
12 |
$427.35 |
| D0603 |
|
3,753 |
3,605 |
$0.00 |