| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
660 |
650 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,353 |
2,314 |
$66K |
| D1120 |
Prophylaxis - child |
1,730 |
1,698 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
588 |
220 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,497 |
2,572 |
$50K |
| D1110 |
Prophylaxis - adult |
838 |
827 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,679 |
1,646 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,491 |
2,454 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,713 |
2,652 |
$33K |
| D0274 |
Bitewings - four radiographic images |
836 |
824 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
272 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
109 |
$4K |
| D1351 |
Sealant - per tooth |
82 |
28 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
30 |
$411.60 |
| D0602 |
|
1,445 |
1,432 |
$0.00 |
| D0603 |
|
1,663 |
1,640 |
$0.00 |
| D0601 |
|
55 |
47 |
$0.00 |