| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,788 |
3,752 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
4,424 |
4,375 |
$119K |
| D0145 |
Oral evaluation for a patient under three years of age |
861 |
856 |
$116K |
| D1351 |
Sealant - per tooth |
2,991 |
315 |
$71K |
| D1110 |
Prophylaxis - adult |
1,002 |
986 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,980 |
2,942 |
$41K |
| D0330 |
Panoramic radiographic image |
724 |
714 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,724 |
1,704 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,549 |
1,538 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
169 |
41 |
$20K |
| D0274 |
Bitewings - four radiographic images |
461 |
450 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
751 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
251 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
57 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
149 |
135 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
120 |
$3K |
| D9248 |
|
28 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
24 |
$3K |
| D0603 |
|
5,328 |
5,275 |
$0.00 |
| D0602 |
|
67 |
67 |
$0.00 |
| D0601 |
|
196 |
196 |
$0.00 |