| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,030 |
969 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
207 |
205 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,740 |
1,168 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
730 |
704 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,333 |
1,247 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,541 |
1,339 |
$15K |
| D1351 |
Sealant - per tooth |
508 |
97 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
223 |
$7K |
| D0274 |
Bitewings - four radiographic images |
196 |
190 |
$6K |
| D0272 |
Bitewings - two radiographic images |
267 |
260 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
27 |
26 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
19 |
17 |
$358.58 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$244.14 |
| D1330 |
|
65 |
62 |
$49.00 |
| D0603 |
|
1,852 |
1,779 |
$0.00 |