| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
771 |
761 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
519 |
248 |
$48K |
| D1120 |
Prophylaxis - child |
1,276 |
1,247 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,310 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,129 |
1,225 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,927 |
1,876 |
$27K |
| D1110 |
Prophylaxis - adult |
477 |
471 |
$25K |
| D1351 |
Sealant - per tooth |
845 |
132 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
539 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,916 |
1,845 |
$19K |
| D0274 |
Bitewings - four radiographic images |
521 |
500 |
$16K |
| D0330 |
Panoramic radiographic image |
283 |
277 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
74 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
186 |
163 |
$5K |
| D0272 |
Bitewings - two radiographic images |
154 |
152 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
14 |
$3K |
| D0603 |
|
2,966 |
2,914 |
$0.00 |