| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,464 |
4,416 |
$619K |
| D1120 |
Prophylaxis - child |
9,652 |
9,547 |
$339K |
| D0120 |
Periodic oral evaluation - established patient |
10,943 |
10,832 |
$305K |
| D1351 |
Sealant - per tooth |
9,408 |
2,342 |
$253K |
| D1110 |
Prophylaxis - adult |
3,728 |
3,691 |
$195K |
| D1206 |
Topical application of fluoride varnish |
13,559 |
13,413 |
$191K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,858 |
1,289 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,002 |
7,671 |
$150K |
| D0274 |
Bitewings - four radiographic images |
4,621 |
4,574 |
$141K |
| D0272 |
Bitewings - two radiographic images |
6,263 |
6,200 |
$131K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
760 |
335 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,384 |
959 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
8,688 |
8,545 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,510 |
2,480 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,113 |
2,949 |
$81K |
| D0330 |
Panoramic radiographic image |
1,828 |
1,817 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
505 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
686 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
79 |
$7K |
| D1354 |
|
51 |
27 |
$348.00 |
| D0603 |
|
18,400 |
18,185 |
$0.00 |