| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,068 |
1,057 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,391 |
547 |
$114K |
| D1351 |
Sealant - per tooth |
3,729 |
585 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,787 |
3,290 |
$92K |
| D1120 |
Prophylaxis - child |
2,205 |
2,138 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,140 |
2,085 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,643 |
1,557 |
$47K |
| D1110 |
Prophylaxis - adult |
951 |
917 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,347 |
3,241 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,217 |
1,145 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,627 |
3,474 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
136 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
160 |
$10K |
| D0272 |
Bitewings - two radiographic images |
408 |
400 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
94 |
32 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
298 |
274 |
$7K |
| D0330 |
Panoramic radiographic image |
335 |
313 |
$3K |
| D0350 |
|
234 |
224 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
16 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$446.96 |
| D0603 |
|
2,869 |
2,805 |
$9.04 |
| D0602 |
|
1,390 |
1,375 |
$0.00 |
| D0601 |
|
70 |
70 |
$0.00 |
| D1999 |
|
19 |
19 |
$0.00 |