| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,469 |
3,419 |
$95K |
| D0145 |
Oral evaluation for a patient under three years of age |
619 |
610 |
$82K |
| D1120 |
Prophylaxis - child |
2,417 |
2,377 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
833 |
457 |
$76K |
| D1351 |
Sealant - per tooth |
2,933 |
712 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,895 |
1,866 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,847 |
3,790 |
$53K |
| D1110 |
Prophylaxis - adult |
1,026 |
1,012 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,934 |
3,861 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,836 |
3,765 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,486 |
1,460 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
204 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
178 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
13 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$767.17 |
| D0603 |
|
3,238 |
3,199 |
$0.00 |
| D0602 |
|
456 |
446 |
$0.00 |
| D0601 |
|
779 |
774 |
$0.00 |
| D9986 |
|
858 |
816 |
$0.00 |