| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
852 |
835 |
$113K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,582 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
3,035 |
2,892 |
$80K |
| D1120 |
Prophylaxis - child |
2,299 |
2,217 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
764 |
376 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,175 |
4,231 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,995 |
3,818 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,932 |
1,810 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,767 |
4,527 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,083 |
1,024 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,573 |
1,507 |
$34K |
| D1351 |
Sealant - per tooth |
1,257 |
245 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
244 |
$31K |
| D0350 |
|
708 |
639 |
$7K |
| D0330 |
Panoramic radiographic image |
240 |
221 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
168 |
$5K |
| D9243 |
|
32 |
13 |
$1K |
| D9239 |
|
13 |
13 |
$627.44 |
| D0170 |
|
32 |
30 |
$357.26 |
| D0603 |
|
5,675 |
5,522 |
$0.13 |