| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
689 |
675 |
$93K |
| D1120 |
Prophylaxis - child |
1,613 |
1,588 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,681 |
1,649 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,471 |
1,447 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,196 |
2,156 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
318 |
161 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,285 |
2,234 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,178 |
2,091 |
$23K |
| D1110 |
Prophylaxis - adult |
394 |
379 |
$21K |
| D1351 |
Sealant - per tooth |
642 |
165 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
598 |
550 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
98 |
$11K |
| D0274 |
Bitewings - four radiographic images |
302 |
293 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
15 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
102 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
136 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$187.80 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$129.37 |
| D0603 |
|
2,423 |
2,378 |
$0.00 |
| D0602 |
|
380 |
376 |
$0.00 |
| D9986 |
|
29 |
26 |
$0.00 |