| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
426 |
420 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,038 |
2,004 |
$56K |
| D1120 |
Prophylaxis - child |
1,433 |
1,395 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,753 |
2,195 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,954 |
2,868 |
$40K |
| D1110 |
Prophylaxis - adult |
801 |
778 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
362 |
173 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,480 |
2,365 |
$23K |
| D1351 |
Sealant - per tooth |
849 |
188 |
$21K |
| D0274 |
Bitewings - four radiographic images |
745 |
720 |
$20K |
| D0272 |
Bitewings - two radiographic images |
667 |
656 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
376 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
52 |
$7K |
| D0330 |
Panoramic radiographic image |
276 |
254 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
59 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$298.21 |
| D0602 |
|
836 |
814 |
$0.00 |
| D0603 |
|
616 |
586 |
$0.00 |
| D0601 |
|
1,019 |
995 |
$0.00 |