| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,021 |
2,980 |
$83K |
| D1120 |
Prophylaxis - child |
2,150 |
2,120 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,408 |
3,359 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,448 |
1,422 |
$46K |
| D1110 |
Prophylaxis - adult |
887 |
872 |
$45K |
| D0145 |
Oral evaluation for a patient under three years of age |
160 |
160 |
$22K |
| D1351 |
Sealant - per tooth |
864 |
170 |
$22K |
| D0272 |
Bitewings - two radiographic images |
904 |
891 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
482 |
448 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
128 |
$9K |
| D2140 |
|
90 |
68 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
410 |
$5K |
| D9248 |
|
25 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
42 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
37 |
$481.12 |
| D0603 |
|
2,654 |
2,481 |
$0.00 |
| D0602 |
|
2,609 |
2,415 |
$0.00 |