| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
853 |
846 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,253 |
2,879 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,731 |
2,660 |
$76K |
| D1351 |
Sealant - per tooth |
2,893 |
718 |
$74K |
| D1120 |
Prophylaxis - child |
1,948 |
1,910 |
$69K |
| D1110 |
Prophylaxis - adult |
999 |
969 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,446 |
3,365 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,123 |
3,014 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
145 |
$29K |
| D0274 |
Bitewings - four radiographic images |
805 |
780 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
387 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
214 |
209 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
83 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
279 |
266 |
$7K |
| D0272 |
Bitewings - two radiographic images |
228 |
225 |
$5K |
| D0350 |
|
244 |
240 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D0603 |
|
5,004 |
4,925 |
$0.01 |