| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,432 |
3,389 |
$471K |
| D1351 |
Sealant - per tooth |
12,627 |
1,536 |
$326K |
| D1120 |
Prophylaxis - child |
8,410 |
8,269 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,772 |
9,796 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
7,873 |
7,755 |
$216K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,330 |
10,164 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
10,505 |
10,322 |
$124K |
| D0272 |
Bitewings - two radiographic images |
4,486 |
4,414 |
$100K |
| D1110 |
Prophylaxis - adult |
1,858 |
1,837 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,488 |
2,438 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,908 |
1,888 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
254 |
$46K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
100 |
50 |
$14K |
| D9248 |
|
54 |
51 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
141 |
137 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
184 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$892.92 |
| D0602 |
|
3,452 |
3,425 |
$0.00 |
| D0603 |
|
10,035 |
9,910 |
$0.00 |
| D0601 |
|
144 |
144 |
$0.00 |