| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
974 |
937 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,285 |
726 |
$119K |
| D1120 |
Prophylaxis - child |
1,794 |
1,717 |
$59K |
| D1351 |
Sealant - per tooth |
1,649 |
416 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,229 |
1,168 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,176 |
2,094 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,002 |
918 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
402 |
380 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
896 |
862 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
159 |
$20K |
| D0272 |
Bitewings - two radiographic images |
757 |
729 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
801 |
763 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
762 |
472 |
$8K |
| D1110 |
Prophylaxis - adult |
151 |
148 |
$7K |
| D9248 |
|
44 |
41 |
$5K |
| D0274 |
Bitewings - four radiographic images |
141 |
138 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D0350 |
|
35 |
34 |
$510.95 |
| D1354 |
|
33 |
13 |
$338.88 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0603 |
|
3,471 |
3,325 |
$0.00 |
| D0602 |
|
28 |
27 |
$0.00 |