| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
851 |
834 |
$23K |
| D1120 |
Prophylaxis - child |
617 |
610 |
$21K |
| D1110 |
Prophylaxis - adult |
319 |
306 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
92 |
$15K |
| D1351 |
Sealant - per tooth |
562 |
99 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
948 |
931 |
$13K |
| D0274 |
Bitewings - four radiographic images |
407 |
391 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
365 |
325 |
$9K |
| D0272 |
Bitewings - two radiographic images |
392 |
387 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
651 |
635 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
620 |
574 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
29 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
51 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$1K |
| D0603 |
|
1,198 |
1,177 |
$0.00 |