| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,510 |
2,380 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
530 |
511 |
$59K |
| D1120 |
Prophylaxis - child |
1,902 |
1,805 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
684 |
370 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,921 |
2,280 |
$47K |
| D1110 |
Prophylaxis - adult |
799 |
762 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,346 |
1,266 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,723 |
2,588 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
497 |
285 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,616 |
2,462 |
$27K |
| D1351 |
Sealant - per tooth |
707 |
192 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
332 |
292 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
124 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
161 |
$5K |
| D0330 |
Panoramic radiographic image |
36 |
36 |
$622.74 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$558.78 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
26 |
$475.62 |
| D0603 |
|
1,409 |
1,349 |
$1.20 |
| D0602 |
|
899 |
856 |
$0.08 |
| D0601 |
|
980 |
940 |
$0.04 |