| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
808 |
806 |
$110K |
| D1351 |
Sealant - per tooth |
3,711 |
759 |
$101K |
| D1120 |
Prophylaxis - child |
1,921 |
1,911 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,328 |
2,308 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,842 |
2,145 |
$58K |
| D1110 |
Prophylaxis - adult |
1,106 |
1,095 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,309 |
3,286 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,604 |
1,589 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
848 |
841 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,709 |
2,584 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
278 |
140 |
$25K |
| D0330 |
Panoramic radiographic image |
352 |
349 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
61 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
30 |
$723.65 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$202.82 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$186.69 |
| D0602 |
|
508 |
504 |
$0.00 |
| D0601 |
|
2,308 |
2,293 |
$0.00 |
| D0603 |
|
1,134 |
1,126 |
$0.00 |