| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,469 |
1,451 |
$205K |
| D1120 |
Prophylaxis - child |
5,071 |
5,055 |
$184K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,604 |
925 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
5,278 |
5,262 |
$151K |
| D1351 |
Sealant - per tooth |
5,345 |
1,499 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,643 |
902 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,362 |
7,332 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,609 |
4,593 |
$104K |
| D1110 |
Prophylaxis - adult |
1,754 |
1,743 |
$95K |
| D0274 |
Bitewings - four radiographic images |
1,836 |
1,828 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,603 |
1,587 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,503 |
1,439 |
$40K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
223 |
81 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,731 |
2,690 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,501 |
1,456 |
$24K |
| D9248 |
|
61 |
58 |
$7K |
| D0330 |
Panoramic radiographic image |
299 |
298 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$676.08 |
| D0350 |
|
12 |
12 |
$18.38 |
| D0603 |
|
9,697 |
9,610 |
$0.00 |