| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,473 |
5,449 |
$155K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,076 |
1,068 |
$151K |
| D1120 |
Prophylaxis - child |
4,019 |
4,002 |
$144K |
| D0272 |
Bitewings - two radiographic images |
4,389 |
4,373 |
$101K |
| D1110 |
Prophylaxis - adult |
1,659 |
1,653 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,841 |
5,817 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
446 |
$73K |
| D1351 |
Sealant - per tooth |
2,509 |
495 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
4,874 |
4,820 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,951 |
4,533 |
$55K |
| D0330 |
Panoramic radiographic image |
743 |
738 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,063 |
1,007 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
112 |
57 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
67 |
$8K |
| D9248 |
|
15 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
15 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
58 |
$952.14 |
| D0603 |
|
7,515 |
7,428 |
$0.00 |