| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
2,269 |
2,256 |
$319K |
| D1351 |
Sealant - per tooth |
9,869 |
2,578 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,217 |
1,208 |
$223K |
| D1120 |
Prophylaxis - child |
5,918 |
5,870 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
6,349 |
6,302 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,278 |
6,545 |
$149K |
| D1110 |
Prophylaxis - adult |
2,588 |
2,559 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,552 |
8,474 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
1,784 |
1,765 |
$121K |
| D0274 |
Bitewings - four radiographic images |
3,285 |
3,256 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
6,899 |
6,832 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,282 |
2,248 |
$77K |
| D0272 |
Bitewings - two radiographic images |
3,105 |
3,086 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
409 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,474 |
1,242 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
360 |
226 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
135 |
$2K |
| D0603 |
|
11,065 |
10,966 |
$0.00 |
| D9986 |
|
370 |
333 |
$0.00 |