| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
854 |
844 |
$24K |
| D1120 |
Prophylaxis - child |
535 |
529 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
953 |
942 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,355 |
951 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
997 |
981 |
$10K |
| D1110 |
Prophylaxis - adult |
161 |
157 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
26 |
$8K |
| D0274 |
Bitewings - four radiographic images |
236 |
230 |
$7K |
| D0272 |
Bitewings - two radiographic images |
324 |
321 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
28 |
$813.30 |
| D0330 |
Panoramic radiographic image |
30 |
29 |
$729.67 |
| D0602 |
|
522 |
517 |
$0.00 |
| D0603 |
|
73 |
72 |
$0.00 |
| D0601 |
|
80 |
80 |
$0.00 |