| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,834 |
1,680 |
$626.75 |
| D0120 |
Periodic oral evaluation - established patient |
1,771 |
1,626 |
$407.00 |
| D1206 |
Topical application of fluoride varnish |
1,156 |
1,056 |
$329.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,621 |
1,011 |
$282.73 |
| D0220 |
Intraoral - periapical first radiographic image |
1,358 |
1,220 |
$239.26 |
| D1110 |
Prophylaxis - adult |
169 |
151 |
$44.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,030 |
957 |
$36.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
235 |
211 |
$31.00 |
| D0274 |
Bitewings - four radiographic images |
358 |
321 |
$26.00 |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$0.00 |
| D1330 |
|
347 |
327 |
$0.00 |
| D1351 |
Sealant - per tooth |
244 |
92 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
970 |
890 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
358 |
164 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
146 |
$0.00 |
| D0240 |
|
39 |
13 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
39 |
$0.00 |
| D1999 |
|
15 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
219 |
197 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
81 |
$0.00 |