| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
817 |
769 |
$21K |
| D1120 |
Prophylaxis - child |
568 |
546 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,128 |
1,075 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,098 |
1,199 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,509 |
1,328 |
$13K |
| D1351 |
Sealant - per tooth |
406 |
91 |
$11K |
| D1110 |
Prophylaxis - adult |
231 |
217 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
39 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
54 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
52 |
$7K |
| D0274 |
Bitewings - four radiographic images |
245 |
233 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
166 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
131 |
$4K |
| D0272 |
Bitewings - two radiographic images |
248 |
237 |
$4K |
| D0330 |
Panoramic radiographic image |
83 |
79 |
$2K |
| D0603 |
|
1,558 |
1,496 |
$0.03 |