| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,152 |
1,128 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,571 |
809 |
$149K |
| D1351 |
Sealant - per tooth |
4,223 |
621 |
$105K |
| D1120 |
Prophylaxis - child |
2,915 |
2,839 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,558 |
4,214 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,407 |
3,319 |
$94K |
| D1110 |
Prophylaxis - adult |
1,539 |
1,492 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,750 |
1,691 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,638 |
4,453 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,172 |
3,081 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,848 |
1,795 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,064 |
1,021 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
276 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,185 |
1,141 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
479 |
422 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
170 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
69 |
$1K |
| D7111 |
|
41 |
25 |
$423.50 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$336.54 |
| D0603 |
|
3,624 |
3,542 |
$0.00 |
| D0602 |
|
1,995 |
1,959 |
$0.00 |
| D0601 |
|
41 |
33 |
$0.00 |