| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,188 |
10,107 |
$279K |
| D1120 |
Prophylaxis - child |
7,456 |
7,398 |
$258K |
| D1351 |
Sealant - per tooth |
9,218 |
1,485 |
$247K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,804 |
10,633 |
$231K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,440 |
1,426 |
$198K |
| D1110 |
Prophylaxis - adult |
2,911 |
2,893 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,458 |
10,382 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
11,490 |
11,331 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,180 |
3,155 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
906 |
570 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,090 |
674 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,391 |
3,365 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,215 |
2,128 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
410 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
189 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
137 |
$3K |
| D0603 |
|
13,735 |
13,637 |
$0.12 |