| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
6,236 |
1,907 |
$61K |
| D1120 |
Prophylaxis - child |
1,538 |
1,524 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,115 |
1,103 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
305 |
166 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
191 |
191 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,902 |
1,883 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,079 |
2,042 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
558 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
348 |
324 |
$9K |
| D0274 |
Bitewings - four radiographic images |
190 |
186 |
$6K |
| D0272 |
Bitewings - two radiographic images |
236 |
235 |
$5K |
| D1110 |
Prophylaxis - adult |
56 |
55 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
24 |
$2K |
| D0603 |
|
2,862 |
2,839 |
$0.00 |