| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
212 |
200 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
681 |
633 |
$16K |
| D1120 |
Prophylaxis - child |
448 |
414 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,073 |
624 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
679 |
619 |
$7K |
| D1110 |
Prophylaxis - adult |
148 |
144 |
$7K |
| D0274 |
Bitewings - four radiographic images |
227 |
208 |
$6K |
| D0272 |
Bitewings - two radiographic images |
276 |
263 |
$5K |
| D1206 |
Topical application of fluoride varnish |
457 |
431 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
28 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
309 |
300 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
135 |
108 |
$3K |
| D1351 |
Sealant - per tooth |
130 |
28 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
74 |
$2K |
| D0603 |
|
275 |
268 |
$0.04 |
| D0602 |
|
860 |
806 |
$0.00 |