| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,504 |
1,474 |
$202K |
| D1120 |
Prophylaxis - child |
3,109 |
3,041 |
$106K |
| D1351 |
Sealant - per tooth |
4,218 |
707 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,575 |
2,508 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,286 |
3,214 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,716 |
1,682 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
354 |
206 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
985 |
965 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,222 |
2,144 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
994 |
903 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,032 |
1,946 |
$22K |
| D1110 |
Prophylaxis - adult |
368 |
366 |
$19K |
| D0330 |
Panoramic radiographic image |
306 |
295 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
24 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
57 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
40 |
$4K |
| D0274 |
Bitewings - four radiographic images |
81 |
80 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
136 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$191.10 |
| D0603 |
|
5,061 |
4,995 |
$0.00 |