| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,057 |
2,019 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
6,943 |
6,670 |
$184K |
| D1120 |
Prophylaxis - child |
5,046 |
4,909 |
$175K |
| D1351 |
Sealant - per tooth |
6,597 |
1,218 |
$163K |
| D1110 |
Prophylaxis - adult |
2,239 |
2,102 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,233 |
7,002 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,484 |
1,440 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
976 |
499 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,279 |
2,185 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,569 |
5,265 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,972 |
2,831 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,951 |
4,500 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
737 |
705 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
55 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
319 |
306 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
168 |
$6K |
| D0603 |
|
9,606 |
9,394 |
$0.00 |