| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
21,215 |
7,549 |
$226K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,463 |
1,460 |
$205K |
| D1120 |
Prophylaxis - child |
5,611 |
5,602 |
$201K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,312 |
1,207 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
5,937 |
5,928 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,801 |
7,783 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
7,651 |
7,627 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,204 |
2,192 |
$59K |
| D1110 |
Prophylaxis - adult |
929 |
928 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,801 |
1,799 |
$40K |
| D0274 |
Bitewings - four radiographic images |
990 |
989 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
843 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
253 |
150 |
$26K |
| D0330 |
Panoramic radiographic image |
138 |
136 |
$3K |
| D0603 |
|
3,144 |
3,139 |
$0.00 |
| D0602 |
|
6,259 |
6,234 |
$0.00 |