| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,010 |
3,000 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
1,991 |
1,985 |
$138K |
| D1310 |
|
1,081 |
1,078 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
503 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,231 |
1,225 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,507 |
1,503 |
$20K |
| D0603 |
|
1,070 |
1,067 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,057 |
1,532 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,031 |
1,027 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
102 |
101 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
60 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
119 |
$5K |
| D9993 |
|
70 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
270 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
32 |
$2K |
| D9248 |
|
60 |
59 |
$2K |
| D0330 |
Panoramic radiographic image |
36 |
36 |
$1K |
| D9430 |
|
12 |
12 |
$384.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |
| D0350 |
|
16 |
12 |
$153.60 |