| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
874 |
739 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
107 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
226 |
182 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
369 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
480 |
418 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,010 |
855 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
797 |
352 |
$8K |
| D0350 |
|
599 |
465 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
493 |
408 |
$5K |
| D0272 |
Bitewings - two radiographic images |
199 |
147 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80 |
57 |
$1K |
| D0603 |
|
1,368 |
1,284 |
$0.00 |