| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
625 |
600 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,018 |
253 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
745 |
225 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,829 |
1,690 |
$48K |
| D1120 |
Prophylaxis - child |
1,272 |
1,191 |
$42K |
| D1110 |
Prophylaxis - adult |
737 |
677 |
$35K |
| D1351 |
Sealant - per tooth |
1,161 |
297 |
$29K |
| D0274 |
Bitewings - four radiographic images |
955 |
878 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,010 |
1,859 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,834 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,902 |
1,722 |
$20K |
| D0272 |
Bitewings - two radiographic images |
882 |
837 |
$19K |
| D2330 |
|
113 |
32 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
202 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
46 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
28 |
$413.16 |
| D0603 |
|
2,830 |
2,652 |
$99.00 |