| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,083 |
1,060 |
$149K |
| D1120 |
Prophylaxis - child |
2,964 |
2,925 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,301 |
3,254 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
861 |
492 |
$83K |
| D1351 |
Sealant - per tooth |
2,870 |
807 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,270 |
3,623 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,511 |
2,476 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,632 |
3,582 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,951 |
3,869 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
593 |
395 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
274 |
100 |
$35K |
| D1110 |
Prophylaxis - adult |
560 |
556 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,006 |
946 |
$26K |
| D0274 |
Bitewings - four radiographic images |
591 |
578 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
221 |
$8K |
| D9248 |
|
39 |
38 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
64 |
$1K |
| D0330 |
Panoramic radiographic image |
124 |
124 |
$977.32 |
| D0603 |
|
5,057 |
4,971 |
$0.00 |