| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,912 |
2,896 |
$175K |
| D1120 |
Prophylaxis - child |
4,209 |
4,165 |
$174K |
| D1310 |
|
1,942 |
1,930 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,193 |
4,150 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
923 |
406 |
$61K |
| D9993 |
|
1,115 |
1,110 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
504 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
771 |
731 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,804 |
3,168 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,755 |
1,736 |
$20K |
| D0603 |
|
1,287 |
1,275 |
$19K |
| D0274 |
Bitewings - four radiographic images |
576 |
573 |
$12K |
| D1351 |
Sealant - per tooth |
295 |
73 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
67 |
$5K |
| D0602 |
|
202 |
202 |
$3K |