| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
544 |
540 |
$74K |
| D1120 |
Prophylaxis - child |
1,967 |
1,957 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,568 |
1,662 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,591 |
$45K |
| D9248 |
|
287 |
285 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,259 |
2,249 |
$33K |
| D1351 |
Sealant - per tooth |
1,192 |
327 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
144 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,965 |
1,940 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
158 |
69 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
475 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
116 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
397 |
387 |
$7K |
| D1110 |
Prophylaxis - adult |
112 |
112 |
$6K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$4K |
| D0272 |
Bitewings - two radiographic images |
156 |
155 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$325.32 |
| D0603 |
|
3,020 |
3,001 |
$0.00 |