| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,851 |
5,766 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,638 |
2,229 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
16,303 |
16,279 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
908 |
906 |
$0.00 |
| D0603 |
|
6,909 |
6,901 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,363 |
6,259 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13,257 |
13,235 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
8,057 |
8,039 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,212 |
1,211 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
390 |
362 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
128 |
$0.00 |
| D0602 |
|
19 |
19 |
$0.00 |
| D1120 |
Prophylaxis - child |
13,260 |
13,238 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,257 |
4,959 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,397 |
3,067 |
$0.00 |
| D1354 |
|
5,120 |
3,728 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,016 |
1,869 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
9,942 |
9,798 |
$0.00 |
| D2332 |
|
129 |
115 |
$0.00 |
| D0330 |
Panoramic radiographic image |
470 |
470 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
68 |
$0.00 |