| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
398 |
396 |
$55K |
| D1120 |
Prophylaxis - child |
1,461 |
1,432 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,438 |
1,406 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,231 |
1,199 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,760 |
1,728 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,718 |
1,644 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,989 |
1,428 |
$19K |
| D1110 |
Prophylaxis - adult |
235 |
233 |
$11K |
| D0274 |
Bitewings - four radiographic images |
217 |
211 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
36 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
118 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$441.64 |
| D0602 |
|
747 |
741 |
$0.00 |
| D0603 |
|
1,412 |
1,386 |
$0.00 |
| D0601 |
|
50 |
50 |
$0.00 |