| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,378 |
1,357 |
$186K |
| D1351 |
Sealant - per tooth |
3,683 |
675 |
$93K |
| D1120 |
Prophylaxis - child |
2,726 |
2,643 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
651 |
223 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,682 |
2,658 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,042 |
1,980 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
1,008 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,055 |
2,900 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,482 |
1,410 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,621 |
1,572 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,309 |
1,261 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
106 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
564 |
520 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
659 |
637 |
$11K |
| D1110 |
Prophylaxis - adult |
212 |
210 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
71 |
$8K |
| D0274 |
Bitewings - four radiographic images |
142 |
141 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
103 |
98 |
$3K |
| D0603 |
|
4,796 |
4,669 |
$0.00 |