| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,066 |
1,038 |
$124K |
| D1351 |
Sealant - per tooth |
5,109 |
798 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,259 |
3,151 |
$76K |
| D1120 |
Prophylaxis - child |
2,475 |
2,404 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,372 |
3,492 |
$62K |
| D1110 |
Prophylaxis - adult |
1,264 |
1,220 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,829 |
1,764 |
$46K |
| D1206 |
Topical application of fluoride varnish |
3,556 |
3,457 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,898 |
3,728 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
448 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
92 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
133 |
$9K |
| D0272 |
Bitewings - two radiographic images |
403 |
392 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
16 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$807.18 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$308.70 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$167.07 |
| D0350 |
|
30 |
30 |
$147.04 |
| D0603 |
|
2,061 |
2,002 |
$9.12 |
| D0601 |
|
2,763 |
2,695 |
$0.02 |
| D0602 |
|
15 |
15 |
$0.00 |