| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,768 |
2,641 |
$61K |
| D0145 |
Oral evaluation for a patient under three years of age |
665 |
604 |
$49K |
| D1120 |
Prophylaxis - child |
1,892 |
1,781 |
$47K |
| D1110 |
Prophylaxis - adult |
1,036 |
988 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,368 |
3,208 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,457 |
$30K |
| D1351 |
Sealant - per tooth |
1,782 |
280 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,402 |
3,235 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,248 |
3,080 |
$22K |
| D0272 |
Bitewings - two radiographic images |
935 |
879 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
130 |
47 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
243 |
215 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
41 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
171 |
158 |
$3K |
| D0330 |
Panoramic radiographic image |
81 |
79 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$777.04 |
| D0170 |
|
12 |
12 |
$107.51 |
| D0603 |
|
3,713 |
3,495 |
$1.24 |
| D0602 |
|
150 |
150 |
$0.00 |
| D0601 |
|
44 |
44 |
$0.00 |