| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
90 |
$12K |
| D1120 |
Prophylaxis - child |
335 |
329 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
346 |
336 |
$9K |
| D0272 |
Bitewings - two radiographic images |
312 |
309 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
34 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
399 |
$4K |
| D1206 |
Topical application of fluoride varnish |
275 |
266 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
390 |
379 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
113 |
92 |
$3K |
| D1351 |
Sealant - per tooth |
88 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
49 |
48 |
$2K |
| D1110 |
Prophylaxis - adult |
35 |
31 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
84 |
82 |
$1K |
| D0274 |
Bitewings - four radiographic images |
34 |
31 |
$969.08 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
20 |
$635.76 |
| D0603 |
|
541 |
516 |
$0.00 |