| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
247 |
247 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
193 |
$33K |
| D1120 |
Prophylaxis - child |
696 |
682 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
746 |
$21K |
| D0274 |
Bitewings - four radiographic images |
688 |
653 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,828 |
990 |
$20K |
| D1110 |
Prophylaxis - adult |
299 |
297 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
986 |
966 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,128 |
1,095 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
212 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
252 |
238 |
$7K |
| D0272 |
Bitewings - two radiographic images |
153 |
150 |
$3K |
| D1351 |
Sealant - per tooth |
134 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
192 |
191 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$446.91 |
| D0603 |
|
807 |
776 |
$0.00 |
| D0601 |
|
552 |
537 |
$0.00 |
| D0602 |
|
24 |
24 |
$0.00 |