| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,572 |
1,520 |
$167K |
| D1351 |
Sealant - per tooth |
7,725 |
1,207 |
$164K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,095 |
436 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,362 |
3,249 |
$75K |
| D1120 |
Prophylaxis - child |
2,724 |
2,641 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,378 |
4,099 |
$67K |
| D1110 |
Prophylaxis - adult |
1,126 |
1,078 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,749 |
$48K |
| D1206 |
Topical application of fluoride varnish |
3,998 |
3,889 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,439 |
4,260 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
552 |
272 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
680 |
$19K |
| D0272 |
Bitewings - two radiographic images |
902 |
878 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
181 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
14 |
$2K |
| D0603 |
|
3,008 |
2,913 |
$0.05 |
| D0601 |
|
909 |
877 |
$0.02 |
| D0602 |
|
1,829 |
1,765 |
$0.00 |