| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,495 |
1,439 |
$40K |
| D1120 |
Prophylaxis - child |
1,067 |
1,025 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
376 |
103 |
$30K |
| D1110 |
Prophylaxis - adult |
581 |
552 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
204 |
203 |
$28K |
| D0274 |
Bitewings - four radiographic images |
846 |
806 |
$26K |
| D1351 |
Sealant - per tooth |
828 |
145 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,625 |
1,559 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,317 |
1,253 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,598 |
1,508 |
$17K |
| D0272 |
Bitewings - two radiographic images |
489 |
475 |
$11K |
| D1206 |
Topical application of fluoride varnish |
366 |
360 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
96 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
57 |
$2K |
| D0603 |
|
1,705 |
1,647 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0601 |
|
25 |
25 |
$0.00 |