| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,503 |
1,425 |
$197K |
| D1120 |
Prophylaxis - child |
4,965 |
4,769 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,761 |
1,280 |
$163K |
| D1351 |
Sealant - per tooth |
5,489 |
992 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,626 |
1,053 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,345 |
4,123 |
$117K |
| D1110 |
Prophylaxis - adult |
1,970 |
1,901 |
$102K |
| D1206 |
Topical application of fluoride varnish |
7,022 |
6,757 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,446 |
3,303 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,037 |
1,962 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,209 |
1,106 |
$29K |
| D0330 |
Panoramic radiographic image |
881 |
840 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
576 |
551 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,161 |
1,121 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,192 |
787 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
141 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0603 |
|
3,630 |
3,471 |
$0.15 |
| D0602 |
|
2,861 |
2,715 |
$0.08 |