| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,547 |
5,458 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
6,156 |
6,043 |
$135K |
| D1206 |
Topical application of fluoride varnish |
6,834 |
6,728 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,998 |
6,989 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,502 |
7,290 |
$78K |
| D0272 |
Bitewings - two radiographic images |
3,922 |
3,839 |
$64K |
| D1110 |
Prophylaxis - adult |
1,324 |
1,298 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,752 |
1,737 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
613 |
283 |
$48K |
| D0330 |
Panoramic radiographic image |
1,057 |
1,044 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
706 |
705 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
111 |
109 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$886.47 |
| D0707 |
|
40 |
40 |
$210.33 |
| D0603 |
|
1,443 |
1,339 |
$0.00 |
| D0601 |
|
399 |
391 |
$0.00 |
| D0602 |
|
1,256 |
1,220 |
$0.00 |