| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,465 |
4,404 |
$227K |
| D1206 |
Topical application of fluoride varnish |
4,841 |
4,780 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
3,693 |
3,654 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
571 |
$34K |
| D0272 |
Bitewings - two radiographic images |
734 |
720 |
$22K |
| D0274 |
Bitewings - four radiographic images |
324 |
322 |
$14K |
| D1110 |
Prophylaxis - adult |
193 |
190 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
581 |
550 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
54 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
112 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
62 |
62 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$588.00 |
| D0240 |
|
29 |
15 |
$494.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
19 |
$323.00 |