| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,568 |
2,512 |
$339K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,398 |
1,102 |
$237K |
| D1120 |
Prophylaxis - child |
4,293 |
4,225 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,859 |
6,344 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
4,144 |
4,085 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,185 |
6,083 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,162 |
3,086 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
980 |
537 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
6,609 |
6,491 |
$71K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,287 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,696 |
1,654 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,024 |
1,855 |
$52K |
| D1351 |
Sealant - per tooth |
1,569 |
321 |
$41K |
| D7240 |
Removal of impacted tooth - completely bony |
90 |
25 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
139 |
43 |
$20K |
| D0330 |
Panoramic radiographic image |
857 |
844 |
$9K |
| D0272 |
Bitewings - two radiographic images |
401 |
397 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D9222 |
|
29 |
26 |
$1K |
| D9248 |
|
12 |
12 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
29 |
26 |
$1K |
| D0160 |
|
42 |
39 |
$553.15 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$413.16 |
| D0603 |
|
10,200 |
9,998 |
$0.01 |