| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,380 |
4,344 |
$247K |
| D1120 |
Prophylaxis - child |
5,571 |
5,532 |
$223K |
| D1310 |
|
2,013 |
1,993 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,497 |
5,456 |
$83K |
| D9993 |
|
963 |
961 |
$62K |
| D1351 |
Sealant - per tooth |
1,895 |
471 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,137 |
3,113 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
834 |
733 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,797 |
3,532 |
$31K |
| D0603 |
|
1,719 |
1,698 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
250 |
147 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
245 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,152 |
1,049 |
$13K |
| D0274 |
Bitewings - four radiographic images |
445 |
445 |
$9K |
| D0330 |
Panoramic radiographic image |
208 |
204 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$2K |
| D0350 |
|
25 |
12 |
$220.80 |