| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
940 |
903 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,447 |
1,382 |
$36K |
| D1351 |
Sealant - per tooth |
1,478 |
219 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,749 |
1,632 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
283 |
276 |
$33K |
| D1120 |
Prophylaxis - child |
972 |
947 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,193 |
2,120 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
618 |
582 |
$18K |
| D0330 |
Panoramic radiographic image |
751 |
705 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
108 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,508 |
1,270 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,854 |
1,628 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
165 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
44 |
44 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
14 |
$298.21 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$218.49 |
| D0603 |
|
1,313 |
1,266 |
$0.00 |
| D0601 |
|
1,320 |
1,298 |
$0.00 |
| D0602 |
|
149 |
144 |
$0.00 |