| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,517 |
9,457 |
$266K |
| D1120 |
Prophylaxis - child |
7,303 |
7,261 |
$259K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,818 |
1,803 |
$251K |
| D1351 |
Sealant - per tooth |
8,224 |
2,449 |
$226K |
| D1206 |
Topical application of fluoride varnish |
9,975 |
9,915 |
$142K |
| D1110 |
Prophylaxis - adult |
2,618 |
2,600 |
$136K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
791 |
235 |
$114K |
| D0272 |
Bitewings - two radiographic images |
5,175 |
5,128 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,421 |
2,407 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
910 |
593 |
$68K |
| D9248 |
|
562 |
546 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
447 |
$30K |
| D0330 |
Panoramic radiographic image |
1,217 |
1,204 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,520 |
2,455 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
660 |
648 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,091 |
1,131 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,095 |
1,070 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
68 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
154 |
$3K |
| D0603 |
|
12,324 |
12,238 |
$0.00 |
| D0602 |
|
525 |
524 |
$0.00 |