| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
194 |
177 |
$23K |
| D1351 |
Sealant - per tooth |
683 |
173 |
$18K |
| D1120 |
Prophylaxis - child |
411 |
387 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
52 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
358 |
336 |
$9K |
| D1206 |
Topical application of fluoride varnish |
466 |
440 |
$6K |
| D0272 |
Bitewings - two radiographic images |
262 |
248 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
537 |
320 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
349 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
107 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
111 |
103 |
$3K |
| D1110 |
Prophylaxis - adult |
45 |
45 |
$2K |
| D0274 |
Bitewings - four radiographic images |
78 |
74 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$820.90 |
| D0603 |
|
545 |
514 |
$0.00 |
| D0602 |
|
128 |
117 |
$0.00 |