| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,181 |
1,168 |
$135K |
| D1351 |
Sealant - per tooth |
5,164 |
1,083 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,582 |
4,567 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,937 |
3,882 |
$92K |
| D1120 |
Prophylaxis - child |
2,979 |
2,945 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
974 |
427 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,216 |
2,165 |
$56K |
| D1206 |
Topical application of fluoride varnish |
4,397 |
4,345 |
$48K |
| D1110 |
Prophylaxis - adult |
1,219 |
1,188 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,980 |
4,851 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
480 |
217 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,009 |
909 |
$20K |
| D0272 |
Bitewings - two radiographic images |
796 |
792 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
462 |
$12K |
| D0330 |
Panoramic radiographic image |
170 |
154 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
27 |
$351.31 |
| D0602 |
|
2,935 |
2,891 |
$0.02 |
| D0603 |
|
2,397 |
2,364 |
$0.02 |
| D0601 |
|
534 |
532 |
$0.00 |