| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
792 |
779 |
$110K |
| D1351 |
Sealant - per tooth |
3,519 |
640 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,019 |
2,256 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,287 |
2,218 |
$62K |
| D1120 |
Prophylaxis - child |
1,662 |
1,614 |
$57K |
| D1110 |
Prophylaxis - adult |
984 |
950 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,548 |
2,483 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,504 |
1,469 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,411 |
2,333 |
$29K |
| D0274 |
Bitewings - four radiographic images |
663 |
638 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
133 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
24 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
27 |
$759.08 |
| D0602 |
|
1,930 |
1,900 |
$0.00 |
| D0603 |
|
1,478 |
1,446 |
$0.00 |