| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,483 |
1,448 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,980 |
3,188 |
$109K |
| D1120 |
Prophylaxis - child |
2,771 |
2,708 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,069 |
3,012 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
869 |
490 |
$82K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
392 |
200 |
$54K |
| D1351 |
Sealant - per tooth |
1,862 |
446 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
335 |
$47K |
| D1206 |
Topical application of fluoride varnish |
3,233 |
3,160 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,472 |
3,384 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,241 |
1,215 |
$40K |
| D1110 |
Prophylaxis - adult |
686 |
673 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
878 |
832 |
$23K |
| D9248 |
|
160 |
154 |
$16K |
| D0272 |
Bitewings - two radiographic images |
735 |
708 |
$16K |
| D0350 |
|
773 |
741 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
303 |
$10K |
| D0330 |
Panoramic radiographic image |
384 |
377 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
264 |
257 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
18 |
$2K |
| D1330 |
|
154 |
152 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
67 |
$984.90 |
| D0603 |
|
4,892 |
4,781 |
$0.00 |
| D0601 |
|
25 |
25 |
$0.00 |
| D0602 |
|
27 |
26 |
$0.00 |