| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,884 |
1,866 |
$256K |
| D1120 |
Prophylaxis - child |
2,382 |
2,336 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,139 |
2,410 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,811 |
1,782 |
$49K |
| D1351 |
Sealant - per tooth |
1,620 |
280 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,491 |
2,448 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,616 |
2,547 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
878 |
856 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,191 |
1,170 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
615 |
564 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
52 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
58 |
$4K |
| D1110 |
Prophylaxis - adult |
71 |
69 |
$4K |
| D0274 |
Bitewings - four radiographic images |
92 |
90 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$977.03 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$242.26 |
| D1330 |
|
12 |
12 |
$110.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
12 |
$73.50 |
| D0602 |
|
3,311 |
3,252 |
$0.00 |
| D0603 |
|
1,338 |
1,317 |
$0.00 |