| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
623 |
609 |
$17K |
| D1110 |
Prophylaxis - adult |
330 |
316 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
908 |
880 |
$12K |
| D1120 |
Prophylaxis - child |
329 |
323 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,095 |
713 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
787 |
760 |
$9K |
| D0350 |
|
619 |
601 |
$9K |
| D0274 |
Bitewings - four radiographic images |
253 |
245 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
26 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
134 |
$4K |
| D1351 |
Sealant - per tooth |
104 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
41 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
74 |
55 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D1330 |
|
258 |
248 |
$156.81 |
| D0601 |
|
82 |
80 |
$0.00 |
| D0602 |
|
399 |
385 |
$0.00 |
| D0603 |
|
113 |
107 |
$0.00 |
| D1999 |
|
60 |
54 |
$0.00 |