| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
6,215 |
2,399 |
$67K |
| D1120 |
Prophylaxis - child |
1,738 |
1,680 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,880 |
1,828 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
300 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
410 |
149 |
$41K |
| D1351 |
Sealant - per tooth |
1,340 |
324 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,509 |
2,426 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,652 |
2,557 |
$31K |
| D1110 |
Prophylaxis - adult |
559 |
549 |
$29K |
| D0274 |
Bitewings - four radiographic images |
627 |
609 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
236 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
292 |
$7K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$765.36 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$352.43 |
| D1330 |
|
14 |
14 |
$36.75 |
| D0603 |
|
2,177 |
2,137 |
$0.00 |
| D0602 |
|
574 |
571 |
$0.00 |