| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
611 |
602 |
$83K |
| D1120 |
Prophylaxis - child |
1,583 |
1,519 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,505 |
1,643 |
$41K |
| D1351 |
Sealant - per tooth |
1,030 |
195 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,002 |
965 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
645 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,979 |
1,848 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,151 |
1,107 |
$15K |
| D0272 |
Bitewings - two radiographic images |
581 |
559 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
51 |
$8K |
| D1206 |
Topical application of fluoride varnish |
375 |
362 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
190 |
168 |
$5K |
| D0274 |
Bitewings - four radiographic images |
206 |
188 |
$4K |
| D1110 |
Prophylaxis - adult |
64 |
63 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$777.04 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$206.58 |
| D0350 |
|
23 |
20 |
$128.66 |
| D0603 |
|
2,693 |
2,639 |
$0.00 |