| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
456 |
451 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
262 |
$55K |
| D1351 |
Sealant - per tooth |
2,046 |
515 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,261 |
1,617 |
$50K |
| D1120 |
Prophylaxis - child |
1,397 |
1,369 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,364 |
1,345 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,962 |
1,929 |
$27K |
| D1110 |
Prophylaxis - adult |
447 |
442 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,705 |
1,670 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
303 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
529 |
$17K |
| D0274 |
Bitewings - four radiographic images |
417 |
412 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
141 |
83 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
320 |
308 |
$8K |
| D0272 |
Bitewings - two radiographic images |
347 |
339 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
26 |
$5K |
| D1330 |
|
12 |
12 |
$122.50 |
| D0603 |
|
2,645 |
2,592 |
$0.00 |