| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,269 |
2,255 |
$307K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,568 |
591 |
$212K |
| D1120 |
Prophylaxis - child |
5,602 |
5,538 |
$188K |
| D1351 |
Sealant - per tooth |
5,495 |
1,284 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
4,758 |
4,716 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
626 |
$90K |
| D1206 |
Topical application of fluoride varnish |
6,603 |
6,536 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,252 |
4,211 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,480 |
3,917 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
805 |
520 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,829 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,572 |
4,481 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,453 |
1,377 |
$37K |
| D1110 |
Prophylaxis - adult |
699 |
689 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,091 |
1,078 |
$33K |
| D9248 |
|
195 |
193 |
$22K |
| D0330 |
Panoramic radiographic image |
425 |
419 |
$13K |
| D2934 |
|
48 |
12 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
39 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
116 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D9420 |
|
28 |
27 |
$977.58 |
| D0603 |
|
9,542 |
9,444 |
$0.00 |