| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
367 |
350 |
$49K |
| D1120 |
Prophylaxis - child |
723 |
682 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
578 |
543 |
$15K |
| D0272 |
Bitewings - two radiographic images |
677 |
639 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
945 |
883 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
260 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
894 |
798 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
12 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
386 |
368 |
$5K |
| D1206 |
Topical application of fluoride varnish |
408 |
377 |
$5K |
| D0330 |
Panoramic radiographic image |
173 |
154 |
$4K |
| D1351 |
Sealant - per tooth |
123 |
27 |
$3K |
| D1110 |
Prophylaxis - adult |
75 |
67 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
51 |
46 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
37 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$988.96 |
| D0603 |
|
1,415 |
1,334 |
$0.00 |