| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,853 |
1,828 |
$256K |
| D1120 |
Prophylaxis - child |
3,533 |
3,501 |
$124K |
| D1351 |
Sealant - per tooth |
4,802 |
1,174 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,167 |
543 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,490 |
3,460 |
$97K |
| D9248 |
|
636 |
613 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,587 |
4,545 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,301 |
4,392 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,796 |
4,725 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,322 |
1,311 |
$43K |
| D1110 |
Prophylaxis - adult |
799 |
790 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,399 |
1,388 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
230 |
84 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
796 |
783 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
166 |
$20K |
| D0330 |
Panoramic radiographic image |
432 |
423 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
372 |
362 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
131 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
27 |
$2K |
| D0602 |
|
933 |
928 |
$0.00 |
| D0603 |
|
2,324 |
2,306 |
$0.00 |
| D0601 |
|
2,825 |
2,801 |
$0.00 |