| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,766 |
2,691 |
$74K |
| D1110 |
Prophylaxis - adult |
1,063 |
1,035 |
$53K |
| D1120 |
Prophylaxis - child |
1,488 |
1,455 |
$51K |
| D0240 |
|
3,997 |
1,932 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,476 |
2,423 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,138 |
1,111 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
227 |
226 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
133 |
$24K |
| D0272 |
Bitewings - two radiographic images |
606 |
597 |
$13K |
| D1351 |
Sealant - per tooth |
469 |
106 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
220 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
86 |
$5K |
| D1206 |
Topical application of fluoride varnish |
188 |
185 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$2K |
| D0603 |
|
2,580 |
2,544 |
$333.10 |
| D0602 |
|
191 |
189 |
$9.00 |
| D0601 |
|
101 |
99 |
$0.00 |