| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,565 |
1,553 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
7,636 |
7,583 |
$217K |
| D1120 |
Prophylaxis - child |
5,654 |
5,616 |
$205K |
| D1110 |
Prophylaxis - adult |
2,360 |
2,344 |
$128K |
| D1351 |
Sealant - per tooth |
4,505 |
547 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,138 |
7,639 |
$114K |
| D0272 |
Bitewings - two radiographic images |
4,921 |
4,896 |
$114K |
| D1206 |
Topical application of fluoride varnish |
7,237 |
7,185 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
8,062 |
7,982 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,369 |
2,355 |
$80K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
472 |
332 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
904 |
716 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,768 |
1,675 |
$47K |
| D0330 |
Panoramic radiographic image |
250 |
240 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
551 |
538 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
656 |
651 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
71 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$2K |
| D0270 |
|
31 |
31 |
$147.45 |
| D0601 |
|
3,839 |
3,813 |
$0.00 |
| D0602 |
|
4,202 |
4,179 |
$0.00 |
| D0603 |
|
1,443 |
1,433 |
$0.00 |
| D9986 |
|
213 |
205 |
$0.00 |