| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,844 |
1,820 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
292 |
288 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,432 |
1,410 |
$40K |
| D1120 |
Prophylaxis - child |
1,073 |
1,054 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,811 |
1,775 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,066 |
1,973 |
$21K |
| D0274 |
Bitewings - four radiographic images |
631 |
625 |
$18K |
| D1351 |
Sealant - per tooth |
532 |
132 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
66 |
$12K |
| D1110 |
Prophylaxis - adult |
197 |
195 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
28 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$537.74 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$352.43 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$352.19 |
| D0603 |
|
2,069 |
2,013 |
$0.02 |
| D0602 |
|
349 |
341 |
$0.00 |