| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
775 |
762 |
$17K |
| D0274 |
Bitewings - four radiographic images |
541 |
518 |
$12K |
| D1120 |
Prophylaxis - child |
477 |
467 |
$11K |
| D1110 |
Prophylaxis - adult |
241 |
241 |
$9K |
| D1351 |
Sealant - per tooth |
578 |
149 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
591 |
580 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
74 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
599 |
589 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
543 |
518 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
59 |
59 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
53 |
$4K |
| D0272 |
Bitewings - two radiographic images |
243 |
236 |
$3K |
| D1206 |
Topical application of fluoride varnish |
362 |
355 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
109 |
$2K |
| D0330 |
Panoramic radiographic image |
107 |
106 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
44 |
$637.29 |
| D0603 |
|
910 |
898 |
$0.13 |
| D0601 |
|
29 |
29 |
$0.00 |
| D0602 |
|
81 |
80 |
$0.00 |