| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
659 |
650 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
315 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,016 |
1,921 |
$53K |
| D1120 |
Prophylaxis - child |
1,572 |
1,498 |
$52K |
| D1351 |
Sealant - per tooth |
1,964 |
359 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,509 |
1,917 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,224 |
2,128 |
$30K |
| D1110 |
Prophylaxis - adult |
511 |
502 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,233 |
2,090 |
$25K |
| D0274 |
Bitewings - four radiographic images |
816 |
792 |
$25K |
| D0272 |
Bitewings - two radiographic images |
714 |
678 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
403 |
350 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
29 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
31 |
$988.96 |
| D0330 |
Panoramic radiographic image |
19 |
18 |
$842.95 |
| D0270 |
|
13 |
12 |
$53.90 |
| D0603 |
|
1,303 |
1,269 |
$0.00 |
| D0602 |
|
1,525 |
1,470 |
$0.00 |