| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,129 |
$32K |
| D1120 |
Prophylaxis - child |
901 |
881 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,297 |
1,475 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,535 |
1,499 |
$22K |
| D0274 |
Bitewings - four radiographic images |
694 |
676 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
59 |
$18K |
| D1110 |
Prophylaxis - adult |
335 |
329 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,598 |
1,549 |
$18K |
| D1351 |
Sealant - per tooth |
370 |
54 |
$9K |
| D0272 |
Bitewings - two radiographic images |
426 |
418 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
94 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
126 |
114 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$660.58 |
| D0603 |
|
771 |
676 |
$0.00 |
| D0601 |
|
620 |
590 |
$0.00 |
| D0602 |
|
488 |
454 |
$0.00 |