| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,028 |
989 |
$31K |
| D1120 |
Prophylaxis - child |
826 |
793 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,069 |
1,024 |
$19K |
| D1110 |
Prophylaxis - adult |
205 |
191 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
182 |
$9K |
| D0272 |
Bitewings - two radiographic images |
166 |
160 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
85 |
$2K |
| D1351 |
Sealant - per tooth |
31 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$544.16 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$518.18 |
| D0240 |
|
30 |
14 |
$208.32 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$81.84 |