| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,780 |
1,900 |
$42K |
| D1351 |
Sealant - per tooth |
1,806 |
333 |
$35K |
| D1120 |
Prophylaxis - child |
1,165 |
1,104 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,391 |
1,307 |
$29K |
| D0274 |
Bitewings - four radiographic images |
951 |
892 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
242 |
232 |
$21K |
| D1110 |
Prophylaxis - adult |
535 |
495 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,905 |
1,806 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,193 |
2,046 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
146 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
406 |
384 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
29 |
26 |
$350.70 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$176.28 |
| D0603 |
|
1,359 |
1,302 |
$172.13 |
| D0602 |
|
481 |
458 |
$9.15 |
| D0601 |
|
403 |
359 |
$0.00 |