| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
879 |
787 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
278 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,233 |
1,543 |
$56K |
| D1120 |
Prophylaxis - child |
1,594 |
1,552 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,710 |
1,667 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
197 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,835 |
1,782 |
$26K |
| D0274 |
Bitewings - four radiographic images |
812 |
772 |
$24K |
| D1351 |
Sealant - per tooth |
783 |
176 |
$21K |
| D1110 |
Prophylaxis - adult |
401 |
384 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,673 |
1,615 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
518 |
499 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
77 |
40 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
256 |
$9K |
| D0272 |
Bitewings - two radiographic images |
388 |
381 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
96 |
$7K |
| D0350 |
|
157 |
152 |
$3K |
| D0330 |
Panoramic radiographic image |
147 |
138 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
131 |
$2K |
| D1330 |
|
491 |
467 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
91 |
$911.40 |
| D9920 |
|
285 |
254 |
$0.00 |
| D0601 |
|
142 |
142 |
$0.00 |
| D1310 |
|
365 |
345 |
$0.00 |
| D0603 |
|
2,751 |
2,608 |
$0.00 |
| D0602 |
|
178 |
176 |
$0.00 |
| D0191 |
|
191 |
190 |
$0.00 |