| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,540 |
1,515 |
$43K |
| D1120 |
Prophylaxis - child |
1,034 |
1,012 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,880 |
1,848 |
$27K |
| D1351 |
Sealant - per tooth |
883 |
138 |
$23K |
| D1110 |
Prophylaxis - adult |
423 |
415 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,399 |
1,366 |
$17K |
| D0274 |
Bitewings - four radiographic images |
503 |
495 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,341 |
1,247 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
29 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
242 |
233 |
$5K |
| D0330 |
Panoramic radiographic image |
179 |
172 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
166 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
33 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D1330 |
|
13 |
13 |
$159.25 |
| D0601 |
|
115 |
109 |
$0.00 |
| D0602 |
|
984 |
976 |
$0.00 |
| D0603 |
|
401 |
396 |
$0.00 |