| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,774 |
2,738 |
$380K |
| D1351 |
Sealant - per tooth |
7,772 |
1,831 |
$210K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,473 |
549 |
$204K |
| D1120 |
Prophylaxis - child |
5,348 |
5,271 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
4,448 |
4,396 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,654 |
6,565 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,551 |
2,501 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,864 |
5,529 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
6,022 |
5,895 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
914 |
897 |
$61K |
| D1110 |
Prophylaxis - adult |
1,151 |
1,141 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,750 |
1,729 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,380 |
2,347 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
183 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
738 |
697 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
92 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
244 |
$5K |
| D9248 |
|
27 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
27 |
$3K |
| D0190 |
|
791 |
739 |
$0.00 |
| D1999 |
|
791 |
740 |
$0.00 |
| D0603 |
|
10,367 |
10,178 |
$0.00 |