| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
986 |
962 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,509 |
2,922 |
$68K |
| D1351 |
Sealant - per tooth |
2,737 |
473 |
$56K |
| D1110 |
Prophylaxis - adult |
1,242 |
1,156 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,189 |
2,095 |
$49K |
| D1120 |
Prophylaxis - child |
1,595 |
1,571 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,581 |
1,496 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,362 |
3,158 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,017 |
939 |
$28K |
| D1206 |
Topical application of fluoride varnish |
2,546 |
2,482 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
311 |
163 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
342 |
202 |
$20K |
| D0272 |
Bitewings - two radiographic images |
145 |
145 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$504.08 |
| D0330 |
Panoramic radiographic image |
17 |
16 |
$496.17 |
| D0602 |
|
1,118 |
1,101 |
$0.02 |
| D0603 |
|
2,199 |
2,141 |
$0.00 |
| D0601 |
|
792 |
760 |
$0.00 |