| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
942 |
917 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,457 |
1,296 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
835 |
809 |
$22K |
| D1351 |
Sealant - per tooth |
864 |
169 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
139 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,454 |
1,401 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,026 |
996 |
$14K |
| D0272 |
Bitewings - two radiographic images |
540 |
520 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
219 |
211 |
$7K |
| D0274 |
Bitewings - four radiographic images |
137 |
134 |
$4K |
| D1110 |
Prophylaxis - adult |
79 |
75 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
25 |
$3K |
| D1206 |
Topical application of fluoride varnish |
164 |
161 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
72 |
70 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
39 |
$636.00 |
| D0603 |
|
1,768 |
1,737 |
$0.00 |