| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,826 |
1,762 |
$50K |
| D1120 |
Prophylaxis - child |
1,360 |
1,313 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,724 |
1,518 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,912 |
1,839 |
$27K |
| D0272 |
Bitewings - two radiographic images |
969 |
935 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,708 |
1,627 |
$20K |
| D1351 |
Sealant - per tooth |
578 |
199 |
$15K |
| D1110 |
Prophylaxis - adult |
274 |
256 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
500 |
465 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
90 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
81 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
146 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
47 |
47 |
$7K |
| D0274 |
Bitewings - four radiographic images |
154 |
141 |
$5K |
| D0350 |
|
156 |
144 |
$1K |
| D3120 |
|
121 |
88 |
$28.67 |
| D0603 |
|
3,159 |
2,924 |
$0.00 |
| D1999 |
|
1,942 |
1,756 |
$0.00 |