| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
901 |
896 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
3,762 |
3,730 |
$106K |
| D1120 |
Prophylaxis - child |
2,535 |
2,513 |
$90K |
| D1110 |
Prophylaxis - adult |
1,615 |
1,602 |
$85K |
| D1351 |
Sealant - per tooth |
2,719 |
539 |
$73K |
| D1206 |
Topical application of fluoride varnish |
3,802 |
3,771 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,240 |
2,223 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,432 |
1,422 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
258 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,497 |
2,450 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,428 |
2,252 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
79 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
321 |
280 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
142 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
108 |
$2K |
| D0602 |
|
1,749 |
1,746 |
$0.00 |
| D0603 |
|
3,269 |
3,247 |
$0.00 |