| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,039 |
2,951 |
$82K |
| D1120 |
Prophylaxis - child |
1,870 |
1,847 |
$66K |
| D1110 |
Prophylaxis - adult |
1,155 |
1,119 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,555 |
2,610 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
693 |
675 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
440 |
199 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
278 |
275 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,672 |
2,627 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,080 |
1,035 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,796 |
2,703 |
$33K |
| D0272 |
Bitewings - two radiographic images |
558 |
551 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
358 |
350 |
$12K |
| D1351 |
Sealant - per tooth |
417 |
91 |
$11K |
| D1206 |
Topical application of fluoride varnish |
480 |
465 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$352.43 |
| D0603 |
|
4,406 |
4,330 |
$0.00 |