| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,807 |
1,777 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,202 |
2,165 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,325 |
2,282 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,426 |
1,403 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
205 |
204 |
$28K |
| D1351 |
Sealant - per tooth |
789 |
203 |
$21K |
| D1110 |
Prophylaxis - adult |
377 |
368 |
$20K |
| D0274 |
Bitewings - four radiographic images |
497 |
489 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
655 |
607 |
$17K |
| D0330 |
Panoramic radiographic image |
241 |
232 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
597 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
240 |
132 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0603 |
|
3,034 |
2,993 |
$0.00 |