| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,907 |
1,888 |
$53K |
| D1110 |
Prophylaxis - adult |
881 |
877 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
295 |
295 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,158 |
1,150 |
$37K |
| D1120 |
Prophylaxis - child |
1,011 |
1,003 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,759 |
$26K |
| D0272 |
Bitewings - two radiographic images |
702 |
693 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
88 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
248 |
226 |
$7K |
| D0330 |
Panoramic radiographic image |
111 |
109 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
152 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$1K |
| D0603 |
|
2,482 |
2,468 |
$0.00 |
| D9995 |
|
17 |
17 |
$0.00 |
| D9992 |
|
16 |
16 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |