| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
230 |
230 |
$32K |
| D1120 |
Prophylaxis - child |
881 |
872 |
$30K |
| D1351 |
Sealant - per tooth |
1,061 |
225 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
269 |
110 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
836 |
824 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
135 |
50 |
$17K |
| D0272 |
Bitewings - two radiographic images |
773 |
765 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
128 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,067 |
1,055 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,387 |
1,139 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,212 |
1,195 |
$13K |
| D1110 |
Prophylaxis - adult |
149 |
148 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
194 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
226 |
218 |
$6K |
| D0274 |
Bitewings - four radiographic images |
143 |
142 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
43 |
$4K |
| D9248 |
|
30 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
142 |
142 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$261.04 |
| D0603 |
|
1,467 |
1,453 |
$0.00 |