| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,056 |
1,048 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,282 |
1,272 |
$12K |
| D0240 |
|
1,745 |
910 |
$12K |
| D1120 |
Prophylaxis - child |
917 |
910 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
179 |
$10K |
| D1110 |
Prophylaxis - adult |
242 |
240 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
43 |
$7K |
| D0272 |
Bitewings - two radiographic images |
730 |
723 |
$6K |
| D1330 |
|
1,301 |
1,291 |
$5K |
| D0274 |
Bitewings - four radiographic images |
221 |
221 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
94 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
297 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
287 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$164.56 |