| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
351 |
338 |
$47K |
| D1120 |
Prophylaxis - child |
1,006 |
936 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,049 |
989 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,252 |
1,352 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,613 |
1,491 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,235 |
1,163 |
$16K |
| D0272 |
Bitewings - two radiographic images |
639 |
594 |
$13K |
| D1351 |
Sealant - per tooth |
503 |
133 |
$12K |
| D1110 |
Prophylaxis - adult |
219 |
208 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
297 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
56 |
$9K |
| D0274 |
Bitewings - four radiographic images |
290 |
274 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
86 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$244.14 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$235.20 |
| D0602 |
|
122 |
121 |
$0.00 |
| D0603 |
|
1,824 |
1,755 |
$0.00 |