| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,763 |
1,719 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,730 |
774 |
$163K |
| D1351 |
Sealant - per tooth |
6,010 |
1,125 |
$152K |
| D1120 |
Prophylaxis - child |
3,625 |
3,552 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,072 |
4,004 |
$112K |
| D1110 |
Prophylaxis - adult |
1,450 |
1,426 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,146 |
5,052 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,909 |
1,875 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,763 |
3,586 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,241 |
4,146 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
294 |
72 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,338 |
2,290 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,076 |
$36K |
| D0330 |
Panoramic radiographic image |
918 |
897 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
153 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
446 |
428 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
96 |
$6K |
| D9248 |
|
43 |
41 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$931.48 |
| D0603 |
|
7,536 |
7,424 |
$0.00 |