| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
862 |
856 |
$120K |
| D1110 |
Prophylaxis - adult |
2,284 |
2,255 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
3,970 |
3,903 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,481 |
1,458 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
936 |
421 |
$92K |
| D1120 |
Prophylaxis - child |
2,516 |
2,509 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,798 |
4,759 |
$68K |
| D1351 |
Sealant - per tooth |
2,547 |
537 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,042 |
2,009 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,754 |
1,720 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,217 |
3,996 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,278 |
4,214 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,422 |
1,415 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
13 |
$4K |
| D9248 |
|
29 |
28 |
$4K |
| D4910 |
|
29 |
28 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$704.86 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$233.24 |
| D0603 |
|
6,289 |
6,216 |
$9.00 |