| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,795 |
4,453 |
$125K |
| D1120 |
Prophylaxis - child |
2,978 |
2,756 |
$96K |
| D1110 |
Prophylaxis - adult |
1,926 |
1,796 |
$95K |
| D0272 |
Bitewings - two radiographic images |
4,249 |
3,902 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
555 |
502 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
968 |
537 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,942 |
4,580 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
857 |
491 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,295 |
1,081 |
$28K |
| D0330 |
Panoramic radiographic image |
484 |
469 |
$28K |
| D9248 |
|
484 |
281 |
$27K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
240 |
99 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,088 |
1,662 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,021 |
1,409 |
$16K |
| D1351 |
Sealant - per tooth |
64 |
16 |
$1K |
| D1354 |
|
38 |
27 |
$70.60 |
| D0603 |
|
3,838 |
3,556 |
$0.00 |
| D0602 |
|
1,632 |
1,537 |
$0.00 |