| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
354 |
353 |
$47K |
| D1120 |
Prophylaxis - child |
1,187 |
1,180 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,367 |
1,361 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,360 |
1,334 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,516 |
1,507 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,419 |
$17K |
| D0272 |
Bitewings - two radiographic images |
767 |
763 |
$17K |
| D1110 |
Prophylaxis - adult |
247 |
246 |
$13K |
| D0274 |
Bitewings - four radiographic images |
249 |
248 |
$8K |
| D1351 |
Sealant - per tooth |
300 |
93 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
121 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
48 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D0603 |
|
1,760 |
1,749 |
$0.00 |
| D0602 |
|
35 |
35 |
$0.00 |