| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,920 |
2,802 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
3,609 |
3,481 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
922 |
421 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,113 |
2,971 |
$82K |
| D0145 |
Oral evaluation for a patient under three years of age |
454 |
438 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,279 |
4,137 |
$58K |
| D1120 |
Prophylaxis - child |
1,689 |
1,637 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,910 |
4,525 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
5,036 |
4,740 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,277 |
1,196 |
$38K |
| D0330 |
Panoramic radiographic image |
1,358 |
1,284 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
323 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,042 |
1,007 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
99 |
$14K |
| D1351 |
Sealant - per tooth |
155 |
25 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
18 |
$510.98 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$242.26 |
| D0601 |
|
945 |
928 |
$0.00 |
| D0603 |
|
3,626 |
3,519 |
$0.00 |
| D0602 |
|
871 |
847 |
$0.00 |