| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,845 |
2,810 |
$392K |
| D1351 |
Sealant - per tooth |
11,199 |
2,587 |
$296K |
| D1120 |
Prophylaxis - child |
7,711 |
7,603 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
8,738 |
8,613 |
$243K |
| D1110 |
Prophylaxis - adult |
4,033 |
3,975 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,789 |
1,031 |
$166K |
| D1206 |
Topical application of fluoride varnish |
11,631 |
11,453 |
$164K |
| D0274 |
Bitewings - four radiographic images |
4,734 |
4,658 |
$145K |
| D0272 |
Bitewings - two radiographic images |
5,922 |
5,826 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,487 |
962 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
755 |
242 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,071 |
2,985 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,069 |
5,791 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
6,588 |
6,399 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,552 |
2,402 |
$65K |
| D0330 |
Panoramic radiographic image |
1,461 |
1,429 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
433 |
433 |
$29K |
| D9248 |
|
132 |
125 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
129 |
127 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
83 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
17 |
$1K |
| D1999 |
|
133 |
120 |
$0.00 |
| D0603 |
|
15,342 |
15,086 |
$0.00 |