| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,384 |
1,363 |
$158K |
| D1351 |
Sealant - per tooth |
6,525 |
1,511 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
4,200 |
4,137 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,216 |
703 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,472 |
4,589 |
$92K |
| D1120 |
Prophylaxis - child |
2,834 |
2,805 |
$81K |
| D1110 |
Prophylaxis - adult |
1,671 |
1,644 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,181 |
2,143 |
$59K |
| D1206 |
Topical application of fluoride varnish |
4,541 |
4,487 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,858 |
4,773 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,435 |
1,422 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,156 |
1,072 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
601 |
565 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
127 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$205.80 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$191.36 |
| D0603 |
|
3,638 |
3,595 |
$99.61 |
| D0602 |
|
2,454 |
2,427 |
$0.02 |