| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,725 |
1,683 |
$46K |
| D1110 |
Prophylaxis - adult |
660 |
640 |
$33K |
| D1120 |
Prophylaxis - child |
951 |
930 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,973 |
1,785 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,832 |
1,787 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,860 |
1,816 |
$22K |
| D0272 |
Bitewings - two radiographic images |
761 |
748 |
$17K |
| D0274 |
Bitewings - four radiographic images |
457 |
442 |
$15K |
| D1351 |
Sealant - per tooth |
536 |
119 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
84 |
81 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
40 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
261 |
244 |
$7K |
| D0603 |
|
2,332 |
2,227 |
$0.00 |