| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,849 |
4,633 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
4,997 |
4,804 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,609 |
3,423 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,123 |
2,041 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,123 |
3,865 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,879 |
3,131 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,324 |
2,252 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
175 |
170 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
798 |
727 |
$17K |
| D1110 |
Prophylaxis - adult |
286 |
274 |
$14K |
| D1351 |
Sealant - per tooth |
510 |
117 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
51 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
197 |
$7K |
| D0330 |
Panoramic radiographic image |
121 |
120 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
44 |
$5K |
| D0274 |
Bitewings - four radiographic images |
56 |
52 |
$2K |
| D0603 |
|
7,098 |
6,810 |
$0.00 |