| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,761 |
1,717 |
$47K |
| D1110 |
Prophylaxis - adult |
908 |
880 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,322 |
2,157 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
142 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,108 |
2,059 |
$30K |
| D1351 |
Sealant - per tooth |
1,060 |
206 |
$28K |
| D1120 |
Prophylaxis - child |
803 |
786 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,467 |
2,378 |
$27K |
| D0274 |
Bitewings - four radiographic images |
663 |
633 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
153 |
148 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
330 |
$11K |
| D0272 |
Bitewings - two radiographic images |
185 |
182 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
43 |
$1K |
| D0603 |
|
2,858 |
2,791 |
$0.00 |