| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,280 |
1,240 |
$36K |
| D1110 |
Prophylaxis - adult |
569 |
542 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
121 |
$26K |
| D1120 |
Prophylaxis - child |
708 |
694 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
167 |
165 |
$23K |
| D1351 |
Sealant - per tooth |
754 |
227 |
$21K |
| D0274 |
Bitewings - four radiographic images |
673 |
655 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,302 |
1,260 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
84 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
796 |
213 |
$9K |
| D0272 |
Bitewings - two radiographic images |
405 |
392 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
102 |
$7K |
| D0330 |
Panoramic radiographic image |
305 |
298 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
290 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$325.32 |
| D0602 |
|
35 |
35 |
$0.00 |
| D0603 |
|
1,434 |
1,390 |
$0.00 |