| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
5,879 |
2,254 |
$60K |
| D0145 |
Oral evaluation for a patient under three years of age |
486 |
474 |
$59K |
| D1351 |
Sealant - per tooth |
2,250 |
443 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,032 |
1,957 |
$54K |
| D1120 |
Prophylaxis - child |
1,418 |
1,379 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
156 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,127 |
1,025 |
$33K |
| D1110 |
Prophylaxis - adult |
677 |
630 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,547 |
2,393 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,150 |
1,101 |
$15K |
| D0272 |
Bitewings - two radiographic images |
682 |
665 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,089 |
1,048 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
51 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
188 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
23 |
21 |
$460.87 |
| D0603 |
|
2,349 |
2,284 |
$0.01 |
| D0601 |
|
74 |
73 |
$0.00 |
| D0602 |
|
306 |
297 |
$0.00 |