| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,749 |
2,743 |
$160K |
| D1120 |
Prophylaxis - child |
3,620 |
3,615 |
$148K |
| D1206 |
Topical application of fluoride varnish |
2,372 |
2,369 |
$40K |
| D1351 |
Sealant - per tooth |
911 |
229 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,545 |
2,793 |
$27K |
| D1310 |
|
2,098 |
2,094 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
263 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,545 |
1,545 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,197 |
1,195 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
285 |
268 |
$11K |
| D0274 |
Bitewings - four radiographic images |
531 |
531 |
$11K |
| D0603 |
|
498 |
497 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
71 |
71 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$848.00 |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$840.00 |
| D0350 |
|
41 |
25 |
$412.80 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$144.00 |
| D1330 |
|
2,093 |
2,090 |
$0.00 |