| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,833 |
1,816 |
$252K |
| D1120 |
Prophylaxis - child |
4,378 |
4,297 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,370 |
4,315 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,499 |
5,405 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,200 |
2,117 |
$59K |
| D1110 |
Prophylaxis - adult |
1,022 |
1,002 |
$51K |
| D0350 |
|
5,074 |
4,776 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,140 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,669 |
2,584 |
$29K |
| D1351 |
Sealant - per tooth |
1,047 |
181 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,278 |
1,239 |
$25K |
| D0330 |
Panoramic radiographic image |
469 |
455 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
62 |
25 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
324 |
300 |
$7K |
| D0274 |
Bitewings - four radiographic images |
263 |
260 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0603 |
|
7,406 |
7,273 |
$0.00 |
| D0601 |
|
174 |
171 |
$0.00 |