| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,886 |
2,856 |
$81K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,212 |
$65K |
| D1120 |
Prophylaxis - child |
1,769 |
1,751 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,671 |
1,662 |
$56K |
| D1351 |
Sealant - per tooth |
2,306 |
452 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,906 |
2,882 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
485 |
280 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
237 |
160 |
$21K |
| D0272 |
Bitewings - two radiographic images |
815 |
806 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
850 |
828 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
836 |
595 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
56 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
177 |
$5K |
| D0603 |
|
1,915 |
1,885 |
$0.00 |
| D0601 |
|
625 |
618 |
$0.00 |
| D0602 |
|
736 |
733 |
$0.00 |