| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,227 |
2,185 |
$304K |
| D1351 |
Sealant - per tooth |
7,636 |
1,101 |
$194K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,130 |
426 |
$157K |
| D1120 |
Prophylaxis - child |
4,184 |
4,069 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
2,792 |
2,687 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,121 |
3,029 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,067 |
1,993 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,572 |
4,431 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,199 |
4,022 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,927 |
3,658 |
$41K |
| D0330 |
Panoramic radiographic image |
706 |
684 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,134 |
1,095 |
$29K |
| D1110 |
Prophylaxis - adult |
487 |
467 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
369 |
178 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
645 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
94 |
$12K |
| D0274 |
Bitewings - four radiographic images |
349 |
331 |
$11K |
| D0350 |
|
852 |
766 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0603 |
|
7,165 |
7,035 |
$0.00 |