| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
477 |
468 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
442 |
435 |
$12K |
| D0272 |
Bitewings - two radiographic images |
376 |
371 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
667 |
489 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
479 |
472 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
47 |
47 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
540 |
529 |
$6K |
| D1351 |
Sealant - per tooth |
183 |
45 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
59 |
55 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48 |
47 |
$1K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$734.43 |
| D1330 |
|
41 |
41 |
$441.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$382.20 |
| D0602 |
|
201 |
199 |
$0.00 |
| D0603 |
|
443 |
432 |
$0.00 |