| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,157 |
$32K |
| D1120 |
Prophylaxis - child |
863 |
805 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,391 |
999 |
$24K |
| D1351 |
Sealant - per tooth |
1,055 |
175 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,547 |
1,432 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
70 |
$18K |
| D0274 |
Bitewings - four radiographic images |
568 |
509 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,094 |
$13K |
| D1110 |
Prophylaxis - adult |
265 |
235 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
89 |
83 |
$11K |
| D0330 |
Panoramic radiographic image |
117 |
106 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
75 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
46 |
$2K |
| D0272 |
Bitewings - two radiographic images |
82 |
77 |
$2K |
| D0603 |
|
2,013 |
1,884 |
$0.00 |