| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,955 |
2,938 |
$412K |
| D1351 |
Sealant - per tooth |
13,722 |
2,445 |
$372K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,412 |
1,166 |
$346K |
| D1120 |
Prophylaxis - child |
7,508 |
7,452 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
7,476 |
7,433 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,409 |
8,939 |
$206K |
| D9248 |
|
1,380 |
1,344 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,817 |
8,756 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
9,616 |
9,495 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,490 |
931 |
$111K |
| D0272 |
Bitewings - two radiographic images |
4,254 |
4,226 |
$97K |
| D1110 |
Prophylaxis - adult |
1,468 |
1,459 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,787 |
1,774 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,460 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
736 |
490 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,085 |
1,062 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
186 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,075 |
1,063 |
$20K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$1K |
| D0603 |
|
12,000 |
11,911 |
$0.00 |