| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,119 |
1,109 |
$130K |
| D1351 |
Sealant - per tooth |
5,548 |
1,099 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,379 |
618 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,716 |
3,861 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
3,388 |
3,320 |
$79K |
| D1120 |
Prophylaxis - child |
2,347 |
2,314 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,195 |
2,143 |
$59K |
| D1110 |
Prophylaxis - adult |
1,392 |
1,360 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,684 |
3,622 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,201 |
4,075 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
246 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
607 |
580 |
$17K |
| D0272 |
Bitewings - two radiographic images |
632 |
623 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
609 |
533 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
15 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0603 |
|
2,064 |
2,022 |
$27.22 |
| D0602 |
|
1,106 |
1,092 |
$18.06 |
| D0601 |
|
1,910 |
1,890 |
$0.08 |