| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,059 |
2,056 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
997 |
512 |
$65K |
| D1120 |
Prophylaxis - child |
2,167 |
2,137 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,547 |
2,383 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
537 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,243 |
2,235 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
1,024 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,166 |
1,157 |
$13K |
| D1110 |
Prophylaxis - adult |
132 |
131 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
113 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
178 |
175 |
$8K |
| D1351 |
Sealant - per tooth |
340 |
82 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
144 |
$7K |
| D9430 |
|
98 |
95 |
$3K |
| D0272 |
Bitewings - two radiographic images |
106 |
106 |
$1K |
| D0350 |
|
115 |
51 |
$1K |
| D0240 |
|
19 |
15 |
$180.00 |
| D1999 |
|
171 |
171 |
$0.00 |