| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,148 |
2,105 |
$294K |
| D1120 |
Prophylaxis - child |
3,134 |
3,042 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,507 |
4,659 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,802 |
3,662 |
$104K |
| D1110 |
Prophylaxis - adult |
1,691 |
1,623 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,756 |
4,604 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,086 |
4,878 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,817 |
1,742 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,185 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,866 |
1,811 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
110 |
$35K |
| D1351 |
Sealant - per tooth |
1,181 |
157 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
283 |
275 |
$17K |
| D0330 |
Panoramic radiographic image |
874 |
836 |
$7K |
| D9248 |
|
13 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
24 |
$649.26 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$273.80 |
| D0603 |
|
7,071 |
6,869 |
$0.00 |