| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,059 |
2,027 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
7,101 |
6,898 |
$196K |
| D1351 |
Sealant - per tooth |
7,384 |
1,839 |
$181K |
| D1120 |
Prophylaxis - child |
4,975 |
4,793 |
$173K |
| D1110 |
Prophylaxis - adult |
2,857 |
2,798 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,528 |
975 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,763 |
7,524 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,085 |
3,924 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,357 |
2,317 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,453 |
2,273 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
516 |
507 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
365 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,891 |
1,798 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,532 |
1,422 |
$16K |
| D0330 |
Panoramic radiographic image |
268 |
260 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
173 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$413.16 |
| D0603 |
|
2,851 |
2,800 |
$0.00 |
| D0601 |
|
4,371 |
4,211 |
$0.00 |
| D0602 |
|
3,068 |
2,987 |
$0.00 |
| D9986 |
|
30 |
30 |
$0.00 |