| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,580 |
6,543 |
$186K |
| D1120 |
Prophylaxis - child |
3,860 |
3,840 |
$139K |
| D0145 |
Oral evaluation for a patient under three years of age |
972 |
966 |
$137K |
| D1110 |
Prophylaxis - adult |
2,539 |
2,526 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,736 |
6,700 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,781 |
2,763 |
$94K |
| D1351 |
Sealant - per tooth |
2,491 |
746 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,517 |
2,506 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,964 |
1,842 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
237 |
205 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
64 |
41 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
80 |
$973.24 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$957.30 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$338.02 |
| D0603 |
|
7,849 |
7,802 |
$0.00 |
| D0602 |
|
66 |
65 |
$0.00 |
| D0601 |
|
15 |
14 |
$0.00 |