| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
908 |
904 |
$96K |
| D1351 |
Sealant - per tooth |
4,725 |
861 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,597 |
3,510 |
$80K |
| D1120 |
Prophylaxis - child |
2,758 |
2,700 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
977 |
486 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,142 |
4,065 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,953 |
1,905 |
$51K |
| D1206 |
Topical application of fluoride varnish |
4,070 |
3,974 |
$44K |
| D1110 |
Prophylaxis - adult |
1,010 |
987 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,608 |
4,401 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
400 |
208 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
403 |
$12K |
| D0272 |
Bitewings - two radiographic images |
560 |
553 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
393 |
363 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$3K |
| D0601 |
|
1,399 |
1,369 |
$0.01 |
| D0603 |
|
1,749 |
1,718 |
$0.00 |
| D0602 |
|
1,795 |
1,778 |
$0.00 |