| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,146 |
3,122 |
$431K |
| D1120 |
Prophylaxis - child |
7,397 |
7,268 |
$261K |
| D1351 |
Sealant - per tooth |
9,136 |
2,164 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
7,116 |
6,969 |
$196K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,383 |
597 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,904 |
1,172 |
$173K |
| D1206 |
Topical application of fluoride varnish |
9,620 |
9,445 |
$136K |
| D0272 |
Bitewings - two radiographic images |
5,373 |
5,281 |
$121K |
| D1110 |
Prophylaxis - adult |
2,235 |
2,194 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
1,718 |
1,688 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,190 |
801 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,546 |
2,497 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,997 |
2,784 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,846 |
1,806 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,459 |
2,396 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,029 |
1,831 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
271 |
187 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
316 |
312 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
32 |
$470.40 |
| D0601 |
|
288 |
284 |
$0.00 |
| D0602 |
|
11,077 |
10,930 |
$0.00 |
| D0603 |
|
1,489 |
1,458 |
$0.00 |