| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,321 |
4,178 |
$117K |
| D1120 |
Prophylaxis - child |
2,819 |
2,721 |
$96K |
| D1351 |
Sealant - per tooth |
2,791 |
407 |
$69K |
| D1110 |
Prophylaxis - adult |
1,322 |
1,275 |
$67K |
| D1206 |
Topical application of fluoride varnish |
4,250 |
4,109 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,159 |
2,093 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,629 |
3,479 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,560 |
3,343 |
$37K |
| D0274 |
Bitewings - four radiographic images |
964 |
931 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
447 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
138 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
294 |
273 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
40 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$2K |
| D0602 |
|
4,221 |
4,084 |
$0.00 |
| D0603 |
|
241 |
236 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |