| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
636 |
627 |
$88K |
| D1120 |
Prophylaxis - child |
1,489 |
1,471 |
$52K |
| D1351 |
Sealant - per tooth |
1,912 |
400 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,346 |
1,478 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,352 |
1,331 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,040 |
2,013 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,654 |
1,617 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
415 |
$14K |
| D0274 |
Bitewings - four radiographic images |
425 |
419 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
41 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
25 |
$11K |
| D1110 |
Prophylaxis - adult |
178 |
174 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
75 |
$5K |
| D9248 |
|
38 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
158 |
156 |
$4K |
| D0603 |
|
1,236 |
1,224 |
$0.00 |
| D0601 |
|
1,192 |
1,174 |
$0.00 |
| D0602 |
|
54 |
53 |
$0.00 |