| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
256 |
251 |
$35K |
| D1351 |
Sealant - per tooth |
1,048 |
217 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
498 |
495 |
$14K |
| D1120 |
Prophylaxis - child |
375 |
370 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
745 |
740 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
519 |
461 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
479 |
$6K |
| D0272 |
Bitewings - two radiographic images |
142 |
142 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$2K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$830.64 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$379.54 |
| D0602 |
|
940 |
928 |
$0.00 |
| D0601 |
|
133 |
131 |
$0.00 |