| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,015 |
996 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,772 |
1,739 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,236 |
1,214 |
$37K |
| D1120 |
Prophylaxis - child |
718 |
709 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,536 |
1,853 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,002 |
1,956 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,113 |
1,100 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
37 |
$9K |
| D1206 |
Topical application of fluoride varnish |
623 |
612 |
$9K |
| D0272 |
Bitewings - two radiographic images |
188 |
187 |
$4K |
| D1351 |
Sealant - per tooth |
117 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
191 |
190 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$325.32 |
| D0602 |
|
1,153 |
1,142 |
$0.00 |
| D0603 |
|
522 |
519 |
$0.00 |
| D0601 |
|
82 |
82 |
$0.00 |