| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,010 |
7,944 |
$222K |
| D1351 |
Sealant - per tooth |
7,811 |
1,378 |
$211K |
| D1120 |
Prophylaxis - child |
5,677 |
5,626 |
$198K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,905 |
8,406 |
$191K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,461 |
8,382 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
9,023 |
8,894 |
$107K |
| D0145 |
Oral evaluation for a patient under three years of age |
765 |
760 |
$106K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,895 |
$100K |
| D0272 |
Bitewings - two radiographic images |
2,839 |
2,812 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,728 |
1,703 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
497 |
280 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
277 |
148 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
961 |
917 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
137 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$262.92 |
| D0603 |
|
10,629 |
10,542 |
$0.01 |
| D1999 |
|
425 |
394 |
$0.00 |