| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
5,791 |
5,744 |
$808K |
| D1120 |
Prophylaxis - child |
12,284 |
12,196 |
$444K |
| D1351 |
Sealant - per tooth |
15,815 |
3,647 |
$430K |
| D0120 |
Periodic oral evaluation - established patient |
13,567 |
13,461 |
$386K |
| D1110 |
Prophylaxis - adult |
5,865 |
5,834 |
$316K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,129 |
18,015 |
$263K |
| D0330 |
Panoramic radiographic image |
3,511 |
3,475 |
$211K |
| D0274 |
Bitewings - four radiographic images |
5,293 |
5,268 |
$180K |
| D0272 |
Bitewings - two radiographic images |
7,305 |
7,261 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
13,062 |
12,932 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,805 |
4,759 |
$159K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,342 |
12,174 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
646 |
633 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
144 |
$10K |
| D1354 |
|
247 |
85 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
26 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$352.43 |
| D0270 |
|
44 |
44 |
$215.60 |
| D0602 |
|
2,199 |
2,174 |
$0.00 |
| D0603 |
|
21,669 |
21,383 |
$0.00 |
| D0601 |
|
101 |
100 |
$0.00 |