| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,221 |
3,167 |
$435K |
| D1120 |
Prophylaxis - child |
6,017 |
5,877 |
$206K |
| D1351 |
Sealant - per tooth |
7,814 |
1,301 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
5,719 |
5,602 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,634 |
6,939 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,316 |
7,157 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
7,750 |
7,478 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,461 |
3,389 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
264 |
$53K |
| D1110 |
Prophylaxis - adult |
901 |
882 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,382 |
1,348 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,318 |
1,274 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
197 |
57 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
343 |
205 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
944 |
910 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
214 |
$14K |
| D7962 |
|
68 |
61 |
$6K |
| D0330 |
Panoramic radiographic image |
80 |
79 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
141 |
$3K |
| D7961 |
|
29 |
25 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D1354 |
|
42 |
12 |
$537.32 |
| D0603 |
|
11,424 |
11,217 |
$0.00 |