| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,023 |
1,010 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,853 |
1,046 |
$20K |
| D1120 |
Prophylaxis - child |
529 |
524 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,051 |
1,044 |
$15K |
| D0272 |
Bitewings - two radiographic images |
689 |
685 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,163 |
1,136 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$11K |
| D1110 |
Prophylaxis - adult |
187 |
187 |
$10K |
| D0350 |
|
537 |
531 |
$9K |
| D1351 |
Sealant - per tooth |
282 |
78 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
40 |
$1K |
| D0603 |
|
1,232 |
1,220 |
$7.29 |