| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,482 |
1,477 |
$207K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,006 |
1,004 |
$204K |
| D1120 |
Prophylaxis - child |
5,248 |
5,214 |
$189K |
| D1351 |
Sealant - per tooth |
6,163 |
1,890 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
5,932 |
5,889 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,501 |
6,166 |
$140K |
| D1110 |
Prophylaxis - adult |
2,448 |
2,429 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,811 |
7,755 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,178 |
3,156 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,362 |
1,350 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,416 |
6,361 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,790 |
2,774 |
$64K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
433 |
149 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,817 |
1,803 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
330 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,199 |
1,134 |
$31K |
| D9248 |
|
175 |
165 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
57 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$481.09 |
| D0160 |
|
13 |
13 |
$194.35 |
| D9986 |
|
79 |
79 |
$0.00 |
| D0603 |
|
9,553 |
9,488 |
$0.00 |