| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,002 |
995 |
$138K |
| D1120 |
Prophylaxis - child |
2,242 |
2,202 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
738 |
384 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,814 |
1,747 |
$65K |
| D9248 |
|
465 |
450 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,764 |
1,737 |
$49K |
| D1351 |
Sealant - per tooth |
1,820 |
520 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,610 |
2,565 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,121 |
2,071 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
173 |
111 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
685 |
674 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
116 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
448 |
$8K |
| D1110 |
Prophylaxis - adult |
106 |
106 |
$6K |
| D0272 |
Bitewings - two radiographic images |
211 |
210 |
$5K |
| D0330 |
Panoramic radiographic image |
74 |
73 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
55 |
$1K |
| D0603 |
|
3,716 |
3,669 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |