| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
310 |
306 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
380 |
227 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,298 |
1,279 |
$36K |
| D1120 |
Prophylaxis - child |
902 |
891 |
$31K |
| D1110 |
Prophylaxis - adult |
552 |
540 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
357 |
240 |
$27K |
| D1351 |
Sealant - per tooth |
1,002 |
316 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,403 |
1,115 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,385 |
1,365 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,292 |
1,241 |
$14K |
| D0274 |
Bitewings - four radiographic images |
354 |
345 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
414 |
407 |
$10K |
| D0350 |
|
796 |
783 |
$10K |
| D0272 |
Bitewings - two radiographic images |
367 |
360 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
13 |
$4K |
| D0330 |
Panoramic radiographic image |
66 |
65 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
100 |
$3K |
| D9248 |
|
13 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$413.16 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
32 |
$235.20 |
| D1330 |
|
1,191 |
1,175 |
$117.62 |
| D1310 |
|
308 |
303 |
$0.00 |
| D0603 |
|
1,712 |
1,684 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |