| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
579 |
562 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
107 |
$15K |
| D1120 |
Prophylaxis - child |
427 |
414 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,246 |
317 |
$13K |
| D1351 |
Sealant - per tooth |
449 |
85 |
$10K |
| D1206 |
Topical application of fluoride varnish |
714 |
699 |
$10K |
| D1110 |
Prophylaxis - adult |
177 |
176 |
$9K |
| D0274 |
Bitewings - four radiographic images |
198 |
196 |
$6K |
| D9248 |
|
63 |
59 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
519 |
493 |
$6K |
| D0330 |
Panoramic radiographic image |
139 |
138 |
$6K |
| D0272 |
Bitewings - two radiographic images |
242 |
239 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
176 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
31 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
71 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
134 |
$2K |
| D0603 |
|
984 |
958 |
$0.00 |
| D9986 |
|
107 |
104 |
$0.00 |