| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,165 |
1,142 |
$159K |
| D1120 |
Prophylaxis - child |
3,104 |
3,019 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,187 |
3,116 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
577 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,944 |
2,600 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,554 |
3,474 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
569 |
328 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,630 |
1,579 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,968 |
2,851 |
$35K |
| D1110 |
Prophylaxis - adult |
597 |
587 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,204 |
1,160 |
$30K |
| D0274 |
Bitewings - four radiographic images |
690 |
681 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
606 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
94 |
39 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
86 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
62 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$161.70 |
| D0602 |
|
3,618 |
3,566 |
$0.00 |
| D0603 |
|
1,011 |
1,005 |
$0.00 |
| D0601 |
|
130 |
129 |
$0.00 |