| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
389 |
383 |
$53K |
| D1120 |
Prophylaxis - child |
1,210 |
1,189 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
276 |
78 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,277 |
$36K |
| D1351 |
Sealant - per tooth |
1,214 |
365 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
274 |
173 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,079 |
1,058 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,460 |
1,435 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,857 |
1,473 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,599 |
1,547 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
159 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
414 |
393 |
$11K |
| D1110 |
Prophylaxis - adult |
189 |
187 |
$10K |
| D0274 |
Bitewings - four radiographic images |
201 |
199 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
98 |
$3K |
| D0330 |
Panoramic radiographic image |
45 |
44 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$225.36 |
| D0603 |
|
1,891 |
1,859 |
$0.00 |