| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,847 |
1,776 |
$48K |
| D1120 |
Prophylaxis - child |
1,340 |
1,277 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,538 |
1,864 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,080 |
1,035 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,082 |
1,994 |
$26K |
| D1110 |
Prophylaxis - adult |
455 |
444 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
198 |
191 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,035 |
1,912 |
$22K |
| D1351 |
Sealant - per tooth |
892 |
168 |
$21K |
| D0272 |
Bitewings - two radiographic images |
596 |
569 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
420 |
398 |
$10K |
| D2160 |
|
57 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
25 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$353.20 |
| D1330 |
|
349 |
341 |
$220.50 |
| D0603 |
|
1,270 |
1,229 |
$0.00 |
| D0601 |
|
583 |
553 |
$0.00 |
| D0602 |
|
444 |
426 |
$0.00 |
| D0393 |
|
33 |
33 |
$0.00 |