| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
410 |
407 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
504 |
234 |
$46K |
| D1351 |
Sealant - per tooth |
1,656 |
353 |
$41K |
| D1120 |
Prophylaxis - child |
1,138 |
1,119 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,304 |
1,278 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,837 |
1,517 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,483 |
1,450 |
$20K |
| D0272 |
Bitewings - two radiographic images |
941 |
926 |
$19K |
| D1110 |
Prophylaxis - adult |
371 |
360 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
157 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,609 |
1,570 |
$17K |
| D0274 |
Bitewings - four radiographic images |
428 |
414 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
88 |
47 |
$11K |
| D9248 |
|
107 |
103 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
342 |
326 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
232 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
96 |
$6K |
| D0330 |
Panoramic radiographic image |
286 |
283 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
125 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
25 |
$2K |
| D0603 |
|
2,006 |
1,977 |
$0.00 |