| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
526 |
523 |
$73K |
| D1120 |
Prophylaxis - child |
1,676 |
1,624 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,041 |
2,165 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,599 |
1,560 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,247 |
2,190 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,436 |
2,352 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
117 |
$22K |
| D1110 |
Prophylaxis - adult |
343 |
338 |
$17K |
| D1351 |
Sealant - per tooth |
623 |
122 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
486 |
469 |
$16K |
| D0274 |
Bitewings - four radiographic images |
397 |
389 |
$12K |
| D0272 |
Bitewings - two radiographic images |
481 |
469 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
248 |
229 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$352.80 |
| D0602 |
|
993 |
980 |
$0.00 |
| D0601 |
|
608 |
591 |
$0.00 |
| D0603 |
|
1,012 |
995 |
$0.00 |
| D1330 |
|
13 |
12 |
$0.00 |
| D9986 |
|
31 |
31 |
$0.00 |