| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,572 |
3,543 |
$101K |
| D1110 |
Prophylaxis - adult |
1,665 |
1,659 |
$89K |
| D1120 |
Prophylaxis - child |
2,318 |
2,306 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,999 |
3,963 |
$58K |
| D0145 |
Oral evaluation for a patient under three years of age |
381 |
378 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,531 |
1,526 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
633 |
290 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,841 |
1,834 |
$42K |
| D1351 |
Sealant - per tooth |
1,586 |
194 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,018 |
973 |
$26K |
| D2140 |
|
268 |
177 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
149 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
123 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
13 |
$287.75 |
| D0603 |
|
1,353 |
1,342 |
$0.00 |
| D0601 |
|
26 |
25 |
$0.00 |
| D0602 |
|
3,140 |
3,096 |
$0.00 |