| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
480 |
471 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
618 |
120 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,376 |
1,287 |
$35K |
| D1120 |
Prophylaxis - child |
1,071 |
1,006 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,352 |
1,226 |
$30K |
| D1110 |
Prophylaxis - adult |
554 |
518 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,792 |
1,664 |
$23K |
| D1351 |
Sealant - per tooth |
905 |
127 |
$18K |
| D0274 |
Bitewings - four radiographic images |
541 |
511 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,349 |
1,234 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
230 |
187 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
350 |
289 |
$9K |
| D0272 |
Bitewings - two radiographic images |
266 |
256 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
135 |
$4K |
| D0330 |
Panoramic radiographic image |
115 |
101 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$2K |
| D0603 |
|
2,455 |
2,330 |
$153.25 |