| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
914 |
735 |
$12K |
| D1110 |
Prophylaxis - adult |
367 |
294 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
419 |
314 |
$0.00 |
| D1120 |
Prophylaxis - child |
621 |
497 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
378 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
368 |
292 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,009 |
802 |
$0.00 |
| D0240 |
|
342 |
259 |
$0.00 |
| D1330 |
|
1,017 |
808 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
469 |
360 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
37 |
$0.00 |
| D1351 |
Sealant - per tooth |
767 |
158 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$0.00 |