| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
138 |
$16K |
| D1120 |
Prophylaxis - child |
637 |
569 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
105 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
130 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
335 |
294 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
122 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
315 |
266 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
255 |
241 |
$6K |
| D1206 |
Topical application of fluoride varnish |
522 |
471 |
$5K |
| D0272 |
Bitewings - two radiographic images |
332 |
298 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
496 |
246 |
$3K |
| D1110 |
Prophylaxis - adult |
50 |
50 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
349 |
323 |
$2K |
| D0330 |
Panoramic radiographic image |
157 |
145 |
$2K |
| D0274 |
Bitewings - four radiographic images |
87 |
84 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
139 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$281.70 |
| D1330 |
|
37 |
33 |
$12.25 |
| D0603 |
|
280 |
264 |
$0.00 |
| D0601 |
|
91 |
91 |
$0.00 |
| D0602 |
|
298 |
283 |
$0.00 |