| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
139 |
133 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
496 |
481 |
$14K |
| D1120 |
Prophylaxis - child |
391 |
375 |
$13K |
| D0272 |
Bitewings - two radiographic images |
485 |
468 |
$11K |
| D1351 |
Sealant - per tooth |
348 |
73 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
546 |
527 |
$8K |
| D1110 |
Prophylaxis - adult |
138 |
135 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
436 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
453 |
415 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
151 |
$4K |
| D0330 |
Panoramic radiographic image |
56 |
51 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
26 |
$918.32 |
| D0350 |
|
30 |
30 |
$551.40 |
| D0603 |
|
500 |
484 |
$0.00 |
| D0601 |
|
206 |
196 |
$0.00 |