| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,610 |
1,589 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,898 |
1,873 |
$53K |
| D0145 |
Oral evaluation for a patient under three years of age |
366 |
364 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,386 |
2,580 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,551 |
2,520 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
125 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,785 |
2,739 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,396 |
1,376 |
$27K |
| D1110 |
Prophylaxis - adult |
346 |
340 |
$19K |
| D1351 |
Sealant - per tooth |
577 |
142 |
$15K |
| D0274 |
Bitewings - four radiographic images |
449 |
442 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
12 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
170 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
116 |
$4K |
| D0330 |
Panoramic radiographic image |
123 |
119 |
$3K |
| D9248 |
|
14 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D0603 |
|
3,699 |
3,661 |
$0.00 |