| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
868 |
851 |
$24K |
| D1120 |
Prophylaxis - child |
570 |
559 |
$20K |
| D1110 |
Prophylaxis - adult |
347 |
341 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
113 |
112 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
906 |
888 |
$13K |
| D0272 |
Bitewings - two radiographic images |
552 |
532 |
$12K |
| D0274 |
Bitewings - four radiographic images |
359 |
353 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
62 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
73 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
362 |
344 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
111 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
243 |
193 |
$2K |
| D1351 |
Sealant - per tooth |
86 |
28 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
22 |
$2K |
| D0350 |
|
83 |
77 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
29 |
$704.86 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$431.94 |
| D0603 |
|
1,189 |
1,159 |
$0.00 |