| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,540 |
1,535 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,482 |
624 |
$150K |
| D1351 |
Sealant - per tooth |
4,549 |
904 |
$124K |
| D1120 |
Prophylaxis - child |
3,021 |
2,998 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,154 |
3,588 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,860 |
2,831 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,787 |
3,755 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,745 |
3,655 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,235 |
$40K |
| D1110 |
Prophylaxis - adult |
600 |
593 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
817 |
802 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
182 |
49 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,109 |
1,102 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
838 |
814 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
69 |
$12K |
| D9248 |
|
54 |
52 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
50 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$951.12 |
| D1330 |
|
44 |
44 |
$369.50 |
| D0601 |
|
1,261 |
1,257 |
$0.00 |
| D0602 |
|
547 |
546 |
$0.00 |
| D0603 |
|
3,615 |
3,577 |
$0.00 |