| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,729 |
4,630 |
$132K |
| D1110 |
Prophylaxis - adult |
2,186 |
2,149 |
$115K |
| D1120 |
Prophylaxis - child |
2,994 |
2,919 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,235 |
3,160 |
$99K |
| D1351 |
Sealant - per tooth |
2,910 |
763 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,194 |
5,063 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
3,795 |
3,695 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,641 |
3,440 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
264 |
254 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,481 |
1,444 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
140 |
$26K |
| D0330 |
Panoramic radiographic image |
642 |
624 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
153 |
153 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
255 |
223 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
31 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
32 |
$1K |
| D0602 |
|
6,069 |
5,850 |
$0.00 |
| D1999 |
|
331 |
288 |
$0.00 |