| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,876 |
1,814 |
$253K |
| D1120 |
Prophylaxis - child |
2,951 |
2,866 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,542 |
2,470 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,273 |
2,212 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,155 |
3,058 |
$44K |
| D1351 |
Sealant - per tooth |
1,751 |
342 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,971 |
2,857 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,933 |
2,625 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
334 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
225 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
48 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D1354 |
|
49 |
12 |
$649.52 |
| D0603 |
|
5,668 |
5,483 |
$0.00 |