| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,716 |
1,011 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
863 |
837 |
$23K |
| D1351 |
Sealant - per tooth |
873 |
193 |
$23K |
| D1120 |
Prophylaxis - child |
638 |
617 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
99 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
129 |
128 |
$18K |
| D1110 |
Prophylaxis - adult |
340 |
331 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,135 |
1,082 |
$13K |
| D0274 |
Bitewings - four radiographic images |
393 |
385 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
835 |
812 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
29 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
103 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
83 |
81 |
$2K |
| D1206 |
Topical application of fluoride varnish |
124 |
120 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$888.44 |
| D0350 |
|
50 |
49 |
$817.90 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$440.08 |
| D0602 |
|
1,203 |
1,176 |
$0.00 |
| D0603 |
|
151 |
145 |
$0.00 |