| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
681 |
676 |
$93K |
| D1120 |
Prophylaxis - child |
1,578 |
1,561 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,461 |
1,443 |
$40K |
| D1351 |
Sealant - per tooth |
1,575 |
261 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
405 |
192 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,326 |
2,300 |
$32K |
| D1110 |
Prophylaxis - adult |
601 |
593 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,285 |
2,243 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
792 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,208 |
1,194 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,398 |
2,349 |
$22K |
| D0274 |
Bitewings - four radiographic images |
567 |
557 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
388 |
356 |
$10K |
| D0330 |
Panoramic radiographic image |
338 |
334 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
59 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$3K |
| D9248 |
|
26 |
26 |
$3K |
| D0603 |
|
3,330 |
3,286 |
$0.00 |