| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
315 |
306 |
$43K |
| D1120 |
Prophylaxis - child |
1,094 |
1,076 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
404 |
395 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
899 |
890 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,679 |
1,647 |
$24K |
| D1110 |
Prophylaxis - adult |
401 |
394 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
643 |
619 |
$21K |
| D0274 |
Bitewings - four radiographic images |
390 |
386 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,068 |
1,048 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,061 |
1,036 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
114 |
26 |
$12K |
| D0272 |
Bitewings - two radiographic images |
371 |
368 |
$8K |
| D1351 |
Sealant - per tooth |
183 |
27 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
39 |
$1K |
| D0603 |
|
1,832 |
1,763 |
$264.01 |
| D0601 |
|
189 |
182 |
$0.00 |