| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
472 |
459 |
$62K |
| D1351 |
Sealant - per tooth |
1,741 |
405 |
$44K |
| D1120 |
Prophylaxis - child |
1,256 |
1,211 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,141 |
1,093 |
$30K |
| D0274 |
Bitewings - four radiographic images |
818 |
784 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
128 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,802 |
1,733 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,916 |
1,632 |
$20K |
| D1110 |
Prophylaxis - adult |
405 |
387 |
$20K |
| D0272 |
Bitewings - two radiographic images |
857 |
830 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
587 |
565 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,302 |
1,249 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
646 |
569 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
128 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
187 |
$3K |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$216.18 |
| D0603 |
|
1,850 |
1,811 |
$0.00 |
| D0602 |
|
493 |
479 |
$0.00 |