| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,722 |
3,639 |
$431K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,984 |
1,478 |
$375K |
| D1351 |
Sealant - per tooth |
9,027 |
1,507 |
$196K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,167 |
376 |
$154K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,393 |
6,178 |
$150K |
| D1120 |
Prophylaxis - child |
4,877 |
4,725 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,911 |
5,732 |
$135K |
| D1206 |
Topical application of fluoride varnish |
6,813 |
6,609 |
$75K |
| D1110 |
Prophylaxis - adult |
1,839 |
1,776 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,699 |
2,617 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
6,791 |
6,463 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
712 |
186 |
$37K |
| D2335 |
|
312 |
152 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,407 |
1,306 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
867 |
824 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,084 |
1,060 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
18 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0601 |
|
1,395 |
1,340 |
$0.00 |
| D0603 |
|
3,629 |
3,529 |
$0.00 |
| D0602 |
|
5,340 |
5,250 |
$0.00 |