| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,795 |
3,718 |
$101K |
| D1110 |
Prophylaxis - adult |
1,554 |
1,524 |
$78K |
| D1120 |
Prophylaxis - child |
2,351 |
2,307 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,258 |
1,232 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,257 |
3,167 |
$38K |
| D1351 |
Sealant - per tooth |
1,421 |
163 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,620 |
1,588 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,194 |
3,031 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,266 |
2,248 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
176 |
174 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,655 |
1,592 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
24 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
94 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$526.27 |
| D0603 |
|
4,522 |
4,464 |
$0.00 |
| D0602 |
|
45 |
45 |
$0.00 |