| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,309 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,357 |
1,564 |
$33K |
| D1120 |
Prophylaxis - child |
885 |
862 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,503 |
1,470 |
$21K |
| D0274 |
Bitewings - four radiographic images |
684 |
664 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,713 |
1,649 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
81 |
$16K |
| D1110 |
Prophylaxis - adult |
260 |
256 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
78 |
77 |
$11K |
| D1351 |
Sealant - per tooth |
377 |
107 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$1K |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$888.44 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$380.24 |
| D0603 |
|
2,103 |
2,072 |
$0.00 |