| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,746 |
2,639 |
$74K |
| D1120 |
Prophylaxis - child |
1,768 |
1,699 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
228 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,155 |
3,024 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
190 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,887 |
2,906 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,203 |
3,056 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,260 |
1,206 |
$25K |
| D1110 |
Prophylaxis - adult |
413 |
399 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
134 |
127 |
$17K |
| D1351 |
Sealant - per tooth |
593 |
129 |
$14K |
| D0274 |
Bitewings - four radiographic images |
403 |
380 |
$12K |
| D0330 |
Panoramic radiographic image |
195 |
185 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
62 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$777.04 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$325.32 |
| D0603 |
|
1,778 |
1,742 |
$0.00 |
| D0602 |
|
903 |
880 |
$0.00 |
| D0601 |
|
216 |
212 |
$0.00 |