| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,909 |
1,868 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,173 |
2,127 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,710 |
1,666 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,500 |
2,440 |
$34K |
| D1110 |
Prophylaxis - adult |
537 |
521 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
145 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
730 |
661 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,378 |
1,349 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
103 |
102 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,280 |
1,244 |
$12K |
| D0272 |
Bitewings - two radiographic images |
228 |
226 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
48 |
$4K |
| D1351 |
Sealant - per tooth |
147 |
48 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
88 |
$3K |
| D0330 |
Panoramic radiographic image |
117 |
112 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$184.04 |
| D0602 |
|
1,929 |
1,881 |
$0.00 |
| D0603 |
|
1,231 |
1,208 |
$0.00 |