| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,683 |
2,569 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
360 |
$70K |
| D1120 |
Prophylaxis - child |
1,758 |
1,682 |
$59K |
| D1110 |
Prophylaxis - adult |
1,100 |
1,057 |
$56K |
| D0145 |
Oral evaluation for a patient under three years of age |
309 |
306 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,906 |
2,794 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,462 |
2,703 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,974 |
2,857 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,000 |
962 |
$32K |
| D1351 |
Sealant - per tooth |
1,184 |
227 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,381 |
1,327 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
72 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
145 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$659.14 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$440.10 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$298.91 |
| D0603 |
|
3,103 |
3,002 |
$33.00 |
| D0602 |
|
125 |
122 |
$0.00 |