| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,398 |
1,397 |
$62K |
| D1120 |
Prophylaxis - child |
1,741 |
1,740 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,918 |
1,917 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,547 |
1,428 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
94 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
632 |
632 |
$10K |
| D1330 |
|
1,956 |
1,955 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,587 |
1,572 |
$6K |
| D0330 |
Panoramic radiographic image |
131 |
131 |
$5K |
| D1110 |
Prophylaxis - adult |
203 |
203 |
$4K |
| D1351 |
Sealant - per tooth |
393 |
99 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
37 |
$3K |
| D0272 |
Bitewings - two radiographic images |
386 |
386 |
$3K |
| D0274 |
Bitewings - four radiographic images |
165 |
165 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
50 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
97 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
36 |
36 |
$900.00 |
| D1354 |
|
40 |
12 |
$361.18 |