| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
411 |
402 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
164 |
$41K |
| D1351 |
Sealant - per tooth |
1,182 |
250 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
341 |
326 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
494 |
$17K |
| D1120 |
Prophylaxis - child |
384 |
376 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,121 |
287 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
66 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
294 |
266 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
519 |
503 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
152 |
148 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
322 |
$4K |
| D0350 |
|
353 |
326 |
$3K |
| D1110 |
Prophylaxis - adult |
47 |
46 |
$2K |
| D1330 |
|
106 |
102 |
$1K |
| D0603 |
|
1,096 |
1,071 |
$0.00 |