| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,403 |
1,351 |
$160K |
| D1120 |
Prophylaxis - child |
3,802 |
3,712 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,833 |
3,744 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,904 |
3,816 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,832 |
1,779 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,799 |
1,727 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,645 |
1,562 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
905 |
884 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
110 |
27 |
$14K |
| D1110 |
Prophylaxis - adult |
189 |
183 |
$9K |
| D1351 |
Sealant - per tooth |
318 |
52 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
229 |
$8K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$6K |
| D7962 |
|
49 |
47 |
$4K |
| D9248 |
|
41 |
38 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
24 |
$338.10 |
| D0603 |
|
1,995 |
1,959 |
$0.00 |
| D0602 |
|
3,588 |
3,508 |
$0.00 |