| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,187 |
3,098 |
$86K |
| D1120 |
Prophylaxis - child |
2,214 |
2,159 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,561 |
2,477 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,470 |
1,434 |
$29K |
| D1110 |
Prophylaxis - adult |
546 |
525 |
$25K |
| D0274 |
Bitewings - four radiographic images |
726 |
695 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
570 |
549 |
$15K |
| D1206 |
Topical application of fluoride varnish |
661 |
646 |
$9K |
| D0330 |
Panoramic radiographic image |
96 |
92 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
342 |
317 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
510 |
180 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
16 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$1K |
| D0603 |
|
1,772 |
1,725 |
$0.00 |
| D0602 |
|
1,110 |
1,084 |
$0.00 |