| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
710 |
700 |
$97K |
| D1120 |
Prophylaxis - child |
2,493 |
2,432 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,475 |
2,416 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
579 |
307 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,076 |
3,004 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,608 |
1,575 |
$36K |
| D1351 |
Sealant - per tooth |
1,335 |
287 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,144 |
2,086 |
$26K |
| D1110 |
Prophylaxis - adult |
466 |
461 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,136 |
2,050 |
$24K |
| D0274 |
Bitewings - four radiographic images |
528 |
516 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
467 |
456 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
422 |
389 |
$11K |
| D0330 |
Panoramic radiographic image |
151 |
150 |
$9K |
| D9248 |
|
41 |
40 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
19 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$2K |
| D0602 |
|
1,263 |
1,225 |
$0.00 |
| D0601 |
|
1,038 |
1,014 |
$0.00 |
| D0603 |
|
1,452 |
1,421 |
$0.00 |