| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,629 |
3,624 |
$210K |
| D1120 |
Prophylaxis - child |
4,915 |
4,903 |
$203K |
| D1310 |
|
1,636 |
1,630 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,260 |
2,250 |
$47K |
| D9993 |
|
623 |
623 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,065 |
2,058 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,313 |
2,313 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,274 |
2,161 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
431 |
424 |
$17K |
| D1351 |
Sealant - per tooth |
338 |
96 |
$12K |
| D0603 |
|
806 |
801 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
145 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
70 |
$8K |
| D0350 |
|
646 |
412 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
574 |
561 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
53 |
$3K |
| D0602 |
|
166 |
166 |
$2K |