| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
981 |
965 |
$135K |
| D1351 |
Sealant - per tooth |
3,686 |
702 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,880 |
2,965 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
864 |
416 |
$85K |
| D1120 |
Prophylaxis - child |
2,058 |
2,002 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,267 |
2,188 |
$62K |
| D1110 |
Prophylaxis - adult |
1,029 |
993 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,219 |
3,125 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,182 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,200 |
3,067 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
773 |
746 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
99 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
136 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
39 |
$8K |
| D0330 |
Panoramic radiographic image |
196 |
187 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$325.32 |
| D0603 |
|
2,534 |
2,492 |
$0.01 |
| D1999 |
|
200 |
195 |
$0.00 |
| D0601 |
|
597 |
593 |
$0.00 |
| D0602 |
|
1,015 |
1,000 |
$0.00 |