| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,615 |
3,613 |
$102K |
| D1110 |
Prophylaxis - adult |
1,532 |
1,530 |
$83K |
| D1120 |
Prophylaxis - child |
2,113 |
2,112 |
$76K |
| D0272 |
Bitewings - two radiographic images |
3,152 |
3,149 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,668 |
3,666 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
605 |
372 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
380 |
244 |
$33K |
| D0330 |
Panoramic radiographic image |
379 |
379 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
894 |
859 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,316 |
1,230 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,158 |
997 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
63 |
$9K |
| D9248 |
|
64 |
58 |
$7K |
| D1351 |
Sealant - per tooth |
89 |
26 |
$2K |
| D0603 |
|
2,848 |
2,844 |
$0.00 |
| D0602 |
|
1,106 |
1,106 |
$0.00 |