| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,292 |
1,265 |
$177K |
| D1351 |
Sealant - per tooth |
5,153 |
872 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,081 |
3,976 |
$113K |
| D1120 |
Prophylaxis - child |
3,052 |
2,981 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,545 |
3,407 |
$106K |
| D1110 |
Prophylaxis - adult |
1,408 |
1,365 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
699 |
379 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,740 |
1,691 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
797 |
780 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,657 |
3,556 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,729 |
2,669 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,621 |
1,579 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
152 |
$18K |
| D0272 |
Bitewings - two radiographic images |
728 |
710 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
443 |
382 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
254 |
$9K |
| D1330 |
|
697 |
665 |
$8K |
| D1354 |
|
95 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$1K |
| D9986 |
|
180 |
159 |
$0.00 |
| D0602 |
|
4,180 |
4,082 |
$0.00 |
| D0603 |
|
1,729 |
1,690 |
$0.00 |
| D0601 |
|
46 |
46 |
$0.00 |