| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,243 |
2,222 |
$309K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,697 |
444 |
$242K |
| D1351 |
Sealant - per tooth |
6,258 |
1,299 |
$162K |
| D1120 |
Prophylaxis - child |
3,566 |
3,521 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,734 |
3,758 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,567 |
3,516 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,524 |
4,469 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,283 |
4,186 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
298 |
$40K |
| D1110 |
Prophylaxis - adult |
760 |
750 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,125 |
1,111 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,741 |
1,712 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
193 |
$30K |
| D9248 |
|
271 |
254 |
$30K |
| D0274 |
Bitewings - four radiographic images |
944 |
933 |
$25K |
| D0330 |
Panoramic radiographic image |
769 |
759 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
713 |
643 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
73 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
119 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$450.72 |
| D1354 |
|
39 |
13 |
$420.50 |
| D1330 |
|
128 |
126 |
$98.00 |
| D1310 |
|
31 |
31 |
$0.00 |
| D0603 |
|
7,139 |
7,075 |
$0.00 |