| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,527 |
2,517 |
$352K |
| D1120 |
Prophylaxis - child |
7,239 |
7,166 |
$258K |
| D0120 |
Periodic oral evaluation - established patient |
7,845 |
7,768 |
$220K |
| D1351 |
Sealant - per tooth |
4,765 |
1,115 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,321 |
5,255 |
$122K |
| D1206 |
Topical application of fluoride varnish |
8,215 |
8,144 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,287 |
691 |
$118K |
| D0272 |
Bitewings - two radiographic images |
3,529 |
3,480 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
6,182 |
6,022 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
877 |
522 |
$65K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
452 |
142 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,424 |
2,361 |
$61K |
| D1110 |
Prophylaxis - adult |
1,102 |
1,094 |
$59K |
| D0330 |
Panoramic radiographic image |
507 |
503 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
534 |
$19K |
| D0274 |
Bitewings - four radiographic images |
400 |
392 |
$13K |
| D0350 |
|
301 |
292 |
$5K |
| D2332 |
|
27 |
12 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
55 |
$808.50 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
40 |
$741.42 |
| D0603 |
|
11,364 |
11,292 |
$0.00 |
| D0602 |
|
222 |
218 |
$0.00 |