| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,992 |
1,936 |
$260K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,588 |
1,109 |
$243K |
| D1110 |
Prophylaxis - adult |
3,304 |
3,153 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
5,983 |
5,763 |
$159K |
| D1351 |
Sealant - per tooth |
6,575 |
1,133 |
$158K |
| D1120 |
Prophylaxis - child |
4,145 |
3,994 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,797 |
942 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,688 |
3,556 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,120 |
6,852 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
7,284 |
6,677 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,657 |
5,738 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,770 |
1,648 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,453 |
2,362 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
276 |
75 |
$40K |
| D0330 |
Panoramic radiographic image |
786 |
742 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
404 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
905 |
844 |
$22K |
| D9248 |
|
52 |
52 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
306 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
63 |
62 |
$336.63 |
| D0270 |
|
12 |
12 |
$53.41 |
| D0603 |
|
10,012 |
9,747 |
$0.13 |