| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,903 |
1,872 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,817 |
$52K |
| D0145 |
Oral evaluation for a patient under three years of age |
816 |
802 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,358 |
1,335 |
$27K |
| D1206 |
Topical application of fluoride varnish |
803 |
790 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
125 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,262 |
1,234 |
$20K |
| D1110 |
Prophylaxis - adult |
407 |
404 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
657 |
649 |
$18K |
| D7962 |
|
132 |
66 |
$14K |
| D0272 |
Bitewings - two radiographic images |
630 |
623 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
118 |
$7K |
| D7961 |
|
28 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
74 |
72 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$225.00 |