| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
538 |
528 |
$71K |
| D1120 |
Prophylaxis - child |
1,989 |
1,924 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,825 |
1,779 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
566 |
215 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,709 |
1,640 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,311 |
2,225 |
$29K |
| D1351 |
Sealant - per tooth |
444 |
124 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,013 |
947 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
341 |
299 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
202 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
723 |
651 |
$6K |
| D1110 |
Prophylaxis - adult |
98 |
96 |
$5K |
| D0274 |
Bitewings - four radiographic images |
146 |
141 |
$5K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$718.40 |
| D0603 |
|
3,110 |
3,040 |
$0.00 |