| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
964 |
919 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
726 |
312 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,062 |
1,314 |
$44K |
| D1120 |
Prophylaxis - child |
1,230 |
1,202 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,314 |
$37K |
| D1351 |
Sealant - per tooth |
1,274 |
238 |
$33K |
| D0274 |
Bitewings - four radiographic images |
694 |
668 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,446 |
1,409 |
$20K |
| D1110 |
Prophylaxis - adult |
350 |
338 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,389 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
134 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
554 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
214 |
$7K |
| D0272 |
Bitewings - two radiographic images |
329 |
321 |
$7K |
| D0330 |
Panoramic radiographic image |
213 |
206 |
$6K |
| D0350 |
|
261 |
254 |
$5K |
| D1330 |
|
214 |
200 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$646.80 |
| D0602 |
|
30 |
28 |
$0.00 |
| D0603 |
|
2,499 |
2,420 |
$0.00 |
| D0601 |
|
17 |
16 |
$0.00 |