| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
889 |
842 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
536 |
264 |
$46K |
| D1120 |
Prophylaxis - child |
1,432 |
1,333 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,936 |
1,857 |
$43K |
| D1351 |
Sealant - per tooth |
1,461 |
335 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,222 |
1,113 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
945 |
841 |
$28K |
| D1110 |
Prophylaxis - adult |
589 |
532 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,173 |
1,983 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,667 |
1,563 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
294 |
193 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
792 |
681 |
$18K |
| D0274 |
Bitewings - four radiographic images |
442 |
409 |
$11K |
| D0272 |
Bitewings - two radiographic images |
535 |
503 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
108 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
60 |
56 |
$756.31 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$207.02 |
| D0603 |
|
2,970 |
2,796 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |