| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,556 |
7,538 |
$318K |
| D0120 |
Periodic oral evaluation - established patient |
5,000 |
4,991 |
$318K |
| D1310 |
|
3,247 |
3,240 |
$148K |
| D9993 |
|
1,091 |
1,090 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,622 |
3,614 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,757 |
2,753 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
659 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,542 |
3,160 |
$26K |
| D0603 |
|
1,671 |
1,666 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,048 |
2,045 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
482 |
425 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
84 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
70 |
$4K |
| D0601 |
|
182 |
182 |
$3K |
| D0350 |
|
168 |
87 |
$2K |
| D0274 |
Bitewings - four radiographic images |
51 |
51 |
$999.00 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$450.00 |
| D0602 |
|
15 |
15 |
$225.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |