| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,791 |
1,611 |
$43K |
| D1351 |
Sealant - per tooth |
1,826 |
332 |
$38K |
| D1120 |
Prophylaxis - child |
1,275 |
1,153 |
$38K |
| D1110 |
Prophylaxis - adult |
764 |
675 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,430 |
2,195 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,507 |
2,243 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,246 |
1,133 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,494 |
2,166 |
$22K |
| D0274 |
Bitewings - four radiographic images |
761 |
672 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
294 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
68 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
57 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
73 |
63 |
$8K |
| D0330 |
Panoramic radiographic image |
231 |
186 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
105 |
92 |
$2K |
| D0603 |
|
2,594 |
2,380 |
$0.02 |
| D0601 |
|
71 |
71 |
$0.00 |
| D1330 |
|
25 |
22 |
$0.00 |
| D1310 |
|
29 |
27 |
$0.00 |