| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,292 |
2,287 |
$319K |
| D1120 |
Prophylaxis - child |
4,038 |
3,990 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
3,828 |
3,783 |
$105K |
| D1351 |
Sealant - per tooth |
2,985 |
670 |
$76K |
| D1206 |
Topical application of fluoride varnish |
5,109 |
5,044 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,863 |
3,176 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,727 |
2,698 |
$57K |
| D1110 |
Prophylaxis - adult |
1,108 |
1,094 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,393 |
1,368 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,768 |
3,685 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,430 |
1,402 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
277 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
225 |
93 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,188 |
1,112 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
153 |
$17K |
| D0330 |
Panoramic radiographic image |
447 |
437 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
124 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
24 |
$2K |
| D0603 |
|
7,923 |
7,834 |
$0.00 |