| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,516 |
1,477 |
$39K |
| D1120 |
Prophylaxis - child |
1,417 |
1,380 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,896 |
1,848 |
$21K |
| D0272 |
Bitewings - two radiographic images |
957 |
926 |
$19K |
| D1110 |
Prophylaxis - adult |
379 |
371 |
$18K |
| D0274 |
Bitewings - four radiographic images |
531 |
519 |
$15K |
| D1351 |
Sealant - per tooth |
475 |
69 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
37 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
814 |
459 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
515 |
500 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
174 |
$4K |
| D0330 |
Panoramic radiographic image |
75 |
73 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0603 |
|
1,946 |
1,923 |
$0.00 |