| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,240 |
3,204 |
$90K |
| D1120 |
Prophylaxis - child |
2,307 |
2,280 |
$81K |
| D1110 |
Prophylaxis - adult |
1,041 |
1,028 |
$54K |
| D1206 |
Topical application of fluoride varnish |
3,092 |
3,056 |
$44K |
| D1351 |
Sealant - per tooth |
1,476 |
222 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,474 |
1,458 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
217 |
216 |
$30K |
| D0330 |
Panoramic radiographic image |
496 |
483 |
$27K |
| D0274 |
Bitewings - four radiographic images |
805 |
793 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
41 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
94 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
161 |
159 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$352.43 |
| D0603 |
|
4,200 |
4,163 |
$0.00 |