| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,674 |
3,658 |
$227K |
| D1120 |
Prophylaxis - child |
4,831 |
4,804 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,681 |
4,655 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,215 |
2,778 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
274 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,425 |
1,420 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
52 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
490 |
478 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D1310 |
|
200 |
194 |
$0.00 |
| D1330 |
|
208 |
202 |
$0.00 |