| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,973 |
1,953 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
497 |
290 |
$40K |
| D1110 |
Prophylaxis - adult |
745 |
738 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
235 |
233 |
$32K |
| D1120 |
Prophylaxis - child |
878 |
878 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,971 |
1,967 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,829 |
1,810 |
$21K |
| D0274 |
Bitewings - four radiographic images |
716 |
713 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,486 |
1,438 |
$16K |
| D0272 |
Bitewings - two radiographic images |
636 |
635 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
317 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
127 |
126 |
$8K |
| D0330 |
Panoramic radiographic image |
193 |
192 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
61 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
98 |
$3K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$1K |
| D0603 |
|
3,827 |
3,785 |
$0.00 |