| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,040 |
1,499 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
252 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
994 |
940 |
$25K |
| D1120 |
Prophylaxis - child |
693 |
676 |
$24K |
| D1110 |
Prophylaxis - adult |
491 |
475 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,451 |
1,408 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,676 |
1,594 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
83 |
$17K |
| D0274 |
Bitewings - four radiographic images |
554 |
527 |
$14K |
| D1351 |
Sealant - per tooth |
349 |
65 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
339 |
322 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
28 |
$894.63 |
| D0330 |
Panoramic radiographic image |
36 |
35 |
$171.87 |
| D0603 |
|
583 |
563 |
$54.00 |
| D0602 |
|
1,509 |
1,491 |
$18.20 |
| D0601 |
|
27 |
26 |
$0.00 |