| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,372 |
1,301 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
205 |
$35K |
| D1120 |
Prophylaxis - child |
924 |
894 |
$32K |
| D1110 |
Prophylaxis - adult |
657 |
614 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,502 |
1,440 |
$21K |
| D0274 |
Bitewings - four radiographic images |
668 |
620 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,795 |
1,104 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,234 |
1,161 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
85 |
83 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
426 |
361 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
106 |
99 |
$7K |
| D0272 |
Bitewings - two radiographic images |
199 |
191 |
$4K |
| D9986 |
|
17 |
17 |
$0.00 |
| D0602 |
|
1,403 |
1,354 |
$0.00 |
| D0601 |
|
65 |
65 |
$0.00 |
| D0603 |
|
17 |
17 |
$0.00 |