| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
458 |
451 |
$62K |
| D1120 |
Prophylaxis - child |
1,673 |
1,621 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,328 |
1,284 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,394 |
1,644 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,105 |
1,074 |
$22K |
| D1351 |
Sealant - per tooth |
814 |
172 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,967 |
1,870 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
550 |
540 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,152 |
1,124 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
12 |
$8K |
| D1206 |
Topical application of fluoride varnish |
432 |
413 |
$6K |
| D0330 |
Panoramic radiographic image |
145 |
145 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
118 |
107 |
$3K |
| D0274 |
Bitewings - four radiographic images |
85 |
84 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
23 |
22 |
$1K |
| D0350 |
|
197 |
193 |
$878.55 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
12 |
$262.92 |
| D1330 |
|
126 |
124 |
$86.00 |
| D0603 |
|
2,863 |
2,828 |
$0.00 |