| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
395 |
379 |
$51K |
| D1120 |
Prophylaxis - child |
912 |
887 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
804 |
780 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,830 |
819 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,197 |
1,158 |
$16K |
| D1351 |
Sealant - per tooth |
720 |
84 |
$16K |
| D0272 |
Bitewings - two radiographic images |
661 |
647 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
936 |
896 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
184 |
177 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
25 |
$5K |
| D0330 |
Panoramic radiographic image |
60 |
58 |
$2K |
| D0274 |
Bitewings - four radiographic images |
39 |
37 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$677.75 |
| D0603 |
|
2,063 |
1,983 |
$0.00 |