| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,755 |
1,722 |
$240K |
| D1120 |
Prophylaxis - child |
3,945 |
3,861 |
$131K |
| D1351 |
Sealant - per tooth |
5,090 |
1,027 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
4,582 |
4,495 |
$122K |
| D1110 |
Prophylaxis - adult |
1,584 |
1,549 |
$79K |
| D1206 |
Topical application of fluoride varnish |
5,474 |
5,352 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,344 |
5,189 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,299 |
4,340 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
387 |
40 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,149 |
2,107 |
$41K |
| D0274 |
Bitewings - four radiographic images |
933 |
917 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
135 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
621 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
151 |
$20K |
| D0330 |
Panoramic radiographic image |
387 |
372 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
230 |
211 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$450.72 |
| D0603 |
|
7,605 |
7,487 |
$0.00 |