| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,494 |
2,433 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,828 |
2,761 |
$79K |
| D0145 |
Oral evaluation for a patient under three years of age |
386 |
379 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,885 |
1,852 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,768 |
2,705 |
$40K |
| D1351 |
Sealant - per tooth |
1,045 |
192 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
93 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,592 |
1,540 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,619 |
1,304 |
$16K |
| D1110 |
Prophylaxis - adult |
187 |
183 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
178 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
29 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
47 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
66 |
$970.20 |
| D1330 |
|
1,115 |
1,083 |
$661.50 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$472.92 |
| D0603 |
|
3,593 |
3,525 |
$0.00 |
| D0602 |
|
125 |
122 |
$0.00 |