| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
6,818 |
1,286 |
$71K |
| D0145 |
Oral evaluation for a patient under three years of age |
439 |
419 |
$59K |
| D1351 |
Sealant - per tooth |
1,843 |
393 |
$44K |
| D1120 |
Prophylaxis - child |
1,238 |
1,155 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,154 |
1,076 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
183 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,428 |
1,329 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,423 |
1,312 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
103 |
42 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
66 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
408 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
259 |
$9K |
| D1110 |
Prophylaxis - adult |
123 |
112 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
14 |
$832.66 |
| D1330 |
|
67 |
64 |
$698.25 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$206.58 |
| D0603 |
|
1,945 |
1,830 |
$0.00 |