| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,195 |
2,093 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,725 |
2,590 |
$67K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,998 |
1,901 |
$62K |
| D1120 |
Prophylaxis - child |
2,711 |
2,571 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
543 |
516 |
$24K |
| D1351 |
Sealant - per tooth |
916 |
145 |
$19K |
| D0272 |
Bitewings - two radiographic images |
938 |
883 |
$9K |
| D0240 |
|
987 |
487 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
277 |
239 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
252 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
544 |
511 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
258 |
154 |
$533.25 |
| D1354 |
|
92 |
13 |
$264.00 |