| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,544 |
2,534 |
$140K |
| D1120 |
Prophylaxis - child |
2,306 |
2,302 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,876 |
2,902 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,693 |
1,690 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,374 |
2,371 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
141 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
298 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
52 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
210 |
174 |
$8K |
| D0272 |
Bitewings - two radiographic images |
443 |
441 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
53 |
$5K |
| D1110 |
Prophylaxis - adult |
56 |
55 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |