| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,611 |
1,575 |
$217K |
| D1120 |
Prophylaxis - child |
4,763 |
4,665 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
5,666 |
5,530 |
$155K |
| D1351 |
Sealant - per tooth |
5,321 |
999 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,137 |
6,322 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,013 |
6,841 |
$98K |
| D1110 |
Prophylaxis - adult |
1,815 |
1,757 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
6,968 |
6,698 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,358 |
2,288 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
759 |
470 |
$72K |
| D0272 |
Bitewings - two radiographic images |
2,195 |
2,152 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,104 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
407 |
401 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
392 |
347 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
66 |
$7K |
| D0330 |
Panoramic radiographic image |
219 |
213 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$695.24 |
| D0603 |
|
9,034 |
8,897 |
$0.00 |