| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,064 |
1,039 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,673 |
827 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,922 |
939 |
$134K |
| D1120 |
Prophylaxis - child |
3,068 |
2,984 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,871 |
3,757 |
$104K |
| D1351 |
Sealant - per tooth |
3,941 |
871 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,857 |
4,708 |
$66K |
| D1110 |
Prophylaxis - adult |
1,213 |
1,170 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,940 |
4,743 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,382 |
2,335 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,794 |
4,215 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,175 |
1,065 |
$30K |
| D0274 |
Bitewings - four radiographic images |
708 |
683 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
604 |
581 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
87 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$873.59 |
| D7111 |
|
58 |
38 |
$593.77 |
| D0603 |
|
4,489 |
4,420 |
$1.12 |
| D0602 |
|
986 |
938 |
$0.00 |
| D0601 |
|
255 |
246 |
$0.00 |