| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,704 |
4,662 |
$132K |
| D0145 |
Oral evaluation for a patient under three years of age |
880 |
869 |
$121K |
| D1120 |
Prophylaxis - child |
3,008 |
2,981 |
$106K |
| D1110 |
Prophylaxis - adult |
1,911 |
1,885 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,603 |
5,004 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
940 |
473 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,241 |
5,184 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,328 |
5,247 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,854 |
1,830 |
$55K |
| D1351 |
Sealant - per tooth |
1,383 |
292 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,566 |
1,550 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
81 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
178 |
$6K |
| D0330 |
Panoramic radiographic image |
90 |
88 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
67 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$206.58 |
| D0603 |
|
2,613 |
2,591 |
$10.03 |
| D0601 |
|
2,083 |
2,058 |
$0.00 |
| D0602 |
|
1,171 |
1,151 |
$0.00 |