| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,583 |
4,530 |
$628K |
| D1120 |
Prophylaxis - child |
8,330 |
8,229 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
8,571 |
8,465 |
$235K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,207 |
470 |
$164K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,702 |
1,031 |
$156K |
| D1206 |
Topical application of fluoride varnish |
10,487 |
10,356 |
$145K |
| D0272 |
Bitewings - two radiographic images |
6,334 |
6,259 |
$135K |
| D1110 |
Prophylaxis - adult |
1,783 |
1,755 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,426 |
6,451 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,530 |
7,349 |
$85K |
| D1351 |
Sealant - per tooth |
2,986 |
725 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,368 |
2,327 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,913 |
1,881 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,530 |
1,444 |
$39K |
| D9248 |
|
168 |
162 |
$19K |
| D0330 |
Panoramic radiographic image |
531 |
526 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
64 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
192 |
189 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$2K |
| D0603 |
|
16,003 |
15,786 |
$0.00 |