| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,409 |
2,368 |
$67K |
| D1120 |
Prophylaxis - child |
1,770 |
1,732 |
$61K |
| D1351 |
Sealant - per tooth |
2,042 |
372 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,834 |
2,366 |
$52K |
| D1110 |
Prophylaxis - adult |
983 |
967 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,803 |
2,751 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,224 |
1,205 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,509 |
2,438 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
210 |
204 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,086 |
1,072 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
54 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
104 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
126 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
93 |
$2K |
| D0603 |
|
2,619 |
2,585 |
$0.00 |
| D0602 |
|
474 |
461 |
$0.00 |