| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
653 |
649 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,105 |
3,084 |
$87K |
| D1120 |
Prophylaxis - child |
2,326 |
2,304 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,828 |
1,811 |
$60K |
| D1110 |
Prophylaxis - adult |
979 |
971 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,457 |
3,425 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,829 |
3,778 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,680 |
3,586 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
396 |
238 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,395 |
1,383 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
153 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
468 |
430 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
211 |
$7K |
| D1351 |
Sealant - per tooth |
41 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$191.10 |
| D0601 |
|
649 |
644 |
$0.00 |
| D0603 |
|
2,459 |
2,443 |
$0.00 |
| D0602 |
|
684 |
677 |
$0.00 |