| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
400 |
394 |
$46K |
| D1120 |
Prophylaxis - child |
1,091 |
1,038 |
$31K |
| D1351 |
Sealant - per tooth |
1,033 |
233 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
236 |
138 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
931 |
883 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
143 |
46 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,218 |
1,163 |
$14K |
| D0272 |
Bitewings - two radiographic images |
642 |
608 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,053 |
575 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
230 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
673 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
229 |
217 |
$5K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
28 |
$3K |
| D0274 |
Bitewings - four radiographic images |
81 |
79 |
$3K |
| D1110 |
Prophylaxis - adult |
52 |
50 |
$2K |
| D1354 |
|
102 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
57 |
$1K |
| D0602 |
|
326 |
318 |
$0.00 |
| D0603 |
|
1,578 |
1,493 |
$0.00 |