| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,385 |
1,361 |
$38K |
| D1120 |
Prophylaxis - child |
889 |
876 |
$31K |
| D1110 |
Prophylaxis - adult |
574 |
565 |
$30K |
| D0274 |
Bitewings - four radiographic images |
831 |
816 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,484 |
1,462 |
$21K |
| D0272 |
Bitewings - two radiographic images |
612 |
604 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
93 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
25 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
150 |
122 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
72 |
$837.74 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$623.59 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$225.36 |
| D0603 |
|
1,643 |
1,624 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |