| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
714 |
703 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,496 |
1,202 |
$39K |
| D1120 |
Prophylaxis - child |
1,074 |
1,043 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
849 |
829 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,313 |
1,274 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
85 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,375 |
1,317 |
$16K |
| D1351 |
Sealant - per tooth |
528 |
125 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
255 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
36 |
$5K |
| D0272 |
Bitewings - two radiographic images |
240 |
233 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
105 |
$3K |
| D9248 |
|
13 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
31 |
28 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$847.68 |
| D0603 |
|
2,070 |
2,026 |
$0.00 |
| D0602 |
|
30 |
29 |
$0.00 |