| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,356 |
1,278 |
$33K |
| D1120 |
Prophylaxis - child |
898 |
864 |
$29K |
| D1110 |
Prophylaxis - adult |
389 |
362 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,317 |
1,277 |
$17K |
| D0272 |
Bitewings - two radiographic images |
737 |
710 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,454 |
1,356 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,378 |
1,273 |
$13K |
| D0274 |
Bitewings - four radiographic images |
397 |
361 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
49 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
143 |
18 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
15 |
$379.54 |
| D0603 |
|
1,675 |
1,619 |
$9.03 |