| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
20,897 |
8,464 |
$231K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,639 |
1,624 |
$227K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,222 |
1,111 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
6,894 |
6,866 |
$196K |
| D1110 |
Prophylaxis - adult |
3,546 |
3,523 |
$190K |
| D1120 |
Prophylaxis - child |
4,991 |
4,967 |
$181K |
| D1351 |
Sealant - per tooth |
5,620 |
1,278 |
$151K |
| D0274 |
Bitewings - four radiographic images |
3,905 |
3,886 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,556 |
873 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
8,818 |
8,735 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,922 |
6,881 |
$100K |
| D0272 |
Bitewings - two radiographic images |
4,026 |
4,002 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,423 |
1,404 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,422 |
1,417 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
550 |
533 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
55 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
101 |
$6K |
| D0330 |
Panoramic radiographic image |
486 |
483 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$711.76 |
| D0602 |
|
2,150 |
2,133 |
$0.00 |
| D0603 |
|
7,894 |
7,852 |
$0.00 |