| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,802 |
2,779 |
$77K |
| D1351 |
Sealant - per tooth |
2,721 |
428 |
$73K |
| D1120 |
Prophylaxis - child |
2,095 |
2,080 |
$73K |
| D0272 |
Bitewings - two radiographic images |
1,931 |
1,918 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,327 |
3,271 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,708 |
2,692 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,239 |
2,960 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
255 |
253 |
$34K |
| D1110 |
Prophylaxis - adult |
621 |
614 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
174 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
684 |
660 |
$17K |
| D0274 |
Bitewings - four radiographic images |
467 |
458 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
84 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
292 |
282 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$394.38 |
| D1999 |
|
1,258 |
1,190 |
$0.00 |
| D0603 |
|
3,796 |
3,766 |
$0.00 |