| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,741 |
1,717 |
$235K |
| D1120 |
Prophylaxis - child |
3,219 |
3,113 |
$103K |
| D1351 |
Sealant - per tooth |
4,142 |
1,057 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,195 |
3,080 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
620 |
204 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,528 |
2,782 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,239 |
2,165 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,295 |
3,151 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,564 |
2,486 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
192 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
317 |
310 |
$20K |
| D1110 |
Prophylaxis - adult |
401 |
394 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
572 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
612 |
583 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,049 |
1,013 |
$14K |
| D0274 |
Bitewings - four radiographic images |
374 |
362 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
43 |
$4K |
| D9248 |
|
28 |
24 |
$3K |
| D1354 |
|
226 |
107 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$896.84 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
39 |
$691.10 |
| D0603 |
|
5,495 |
5,369 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |