| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,007 |
1,966 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,188 |
815 |
$208K |
| D1120 |
Prophylaxis - child |
4,023 |
3,934 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,957 |
4,809 |
$134K |
| D1110 |
Prophylaxis - adult |
1,863 |
1,813 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,795 |
2,709 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,105 |
492 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,564 |
5,427 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,815 |
4,909 |
$69K |
| D1351 |
Sealant - per tooth |
2,741 |
633 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,422 |
5,241 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,753 |
2,700 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,277 |
1,241 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
294 |
78 |
$37K |
| D0330 |
Panoramic radiographic image |
1,104 |
1,078 |
$36K |
| D7240 |
Removal of impacted tooth - completely bony |
126 |
38 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
731 |
701 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
254 |
254 |
$17K |
| D9248 |
|
79 |
78 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
267 |
$5K |
| D1206 |
Topical application of fluoride varnish |
144 |
142 |
$2K |
| D9222 |
|
31 |
30 |
$2K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
21 |
17 |
$804.45 |
| D0160 |
|
16 |
16 |
$239.20 |
| D9610 |
|
13 |
13 |
$235.24 |
| D0603 |
|
8,519 |
8,338 |
$0.00 |