| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,453 |
1,437 |
$86K |
| D1120 |
Prophylaxis - child |
1,808 |
1,794 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,244 |
2,108 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
549 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
169 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,975 |
1,960 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,020 |
982 |
$12K |
| D0274 |
Bitewings - four radiographic images |
540 |
536 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
15 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
36 |
$1K |
| D9430 |
|
27 |
25 |
$808.00 |
| D0272 |
Bitewings - two radiographic images |
50 |
49 |
$510.00 |