| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,369 |
1,319 |
$37K |
| D1120 |
Prophylaxis - child |
960 |
905 |
$32K |
| D1110 |
Prophylaxis - adult |
569 |
553 |
$29K |
| D0274 |
Bitewings - four radiographic images |
779 |
753 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,768 |
1,691 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
69 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,507 |
1,434 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,447 |
1,369 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
100 |
93 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
164 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
238 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
26 |
$6K |
| D0272 |
Bitewings - two radiographic images |
266 |
254 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$759.08 |
| D0601 |
|
1,577 |
1,513 |
$0.00 |
| D0602 |
|
247 |
231 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |