| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,702 |
3,637 |
$102K |
| D1120 |
Prophylaxis - child |
2,431 |
2,397 |
$85K |
| D1110 |
Prophylaxis - adult |
1,314 |
1,301 |
$69K |
| D0145 |
Oral evaluation for a patient under three years of age |
476 |
471 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,860 |
3,802 |
$54K |
| D1351 |
Sealant - per tooth |
1,665 |
245 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,600 |
1,568 |
$32K |
| D9248 |
|
237 |
223 |
$24K |
| D0330 |
Panoramic radiographic image |
625 |
614 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,035 |
1,014 |
$12K |
| D0274 |
Bitewings - four radiographic images |
288 |
287 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
42 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
95 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
93 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
125 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$942.63 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D0270 |
|
26 |
24 |
$112.70 |
| D1999 |
|
488 |
432 |
$0.00 |
| D0601 |
|
3,439 |
3,382 |
$0.00 |
| D0602 |
|
859 |
854 |
$0.00 |
| D0603 |
|
403 |
399 |
$0.00 |