| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,422 |
1,332 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,513 |
674 |
$143K |
| D1351 |
Sealant - per tooth |
5,148 |
1,123 |
$130K |
| D1120 |
Prophylaxis - child |
2,934 |
2,812 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,585 |
2,489 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
928 |
504 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,749 |
3,583 |
$51K |
| D1110 |
Prophylaxis - adult |
984 |
918 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
330 |
86 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,431 |
1,318 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,574 |
2,599 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,133 |
2,955 |
$36K |
| D0330 |
Panoramic radiographic image |
917 |
828 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,155 |
2,041 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,014 |
970 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,011 |
943 |
$25K |
| D9248 |
|
127 |
121 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
152 |
151 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
54 |
$939.00 |
| D1206 |
Topical application of fluoride varnish |
60 |
52 |
$762.93 |
| D0603 |
|
5,197 |
5,049 |
$0.06 |
| D9986 |
|
158 |
142 |
$0.00 |
| D0602 |
|
133 |
130 |
$0.00 |