| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,622 |
3,525 |
$185K |
| D1351 |
Sealant - per tooth |
5,638 |
1,205 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
5,280 |
5,152 |
$143K |
| D0274 |
Bitewings - four radiographic images |
3,018 |
2,951 |
$97K |
| D1120 |
Prophylaxis - child |
2,644 |
2,612 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,302 |
5,208 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,405 |
5,260 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,073 |
4,897 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
826 |
806 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
285 |
284 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
348 |
159 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
943 |
905 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,294 |
1,279 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
29 |
$4K |
| D0330 |
Panoramic radiographic image |
117 |
107 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$352.43 |
| D0603 |
|
6,836 |
6,770 |
$0.06 |
| D0602 |
|
46 |
45 |
$0.00 |