| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,586 |
1,565 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
6,943 |
6,887 |
$197K |
| D1120 |
Prophylaxis - child |
5,053 |
5,007 |
$182K |
| D1110 |
Prophylaxis - adult |
2,511 |
2,490 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,513 |
993 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,606 |
7,542 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
720 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,268 |
4,237 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,468 |
2,445 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,849 |
5,791 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,777 |
5,596 |
$65K |
| D1351 |
Sealant - per tooth |
2,015 |
308 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,287 |
1,252 |
$34K |
| D0330 |
Panoramic radiographic image |
1,264 |
1,250 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
353 |
353 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
521 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
185 |
$3K |
| D0602 |
|
770 |
761 |
$0.00 |
| D0601 |
|
493 |
492 |
$0.00 |
| D0603 |
|
7,864 |
7,802 |
$0.00 |