| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
355 |
346 |
$48K |
| D1120 |
Prophylaxis - child |
506 |
494 |
$17K |
| D1351 |
Sealant - per tooth |
646 |
88 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,362 |
731 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
923 |
905 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
283 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
360 |
351 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
844 |
817 |
$9K |
| D0272 |
Bitewings - two radiographic images |
252 |
245 |
$5K |
| D1110 |
Prophylaxis - adult |
75 |
74 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
49 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
48 |
48 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
36 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$263.23 |
| D0603 |
|
1,584 |
1,554 |
$0.00 |