| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,516 |
2,505 |
$149K |
| D1120 |
Prophylaxis - child |
3,319 |
3,300 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,602 |
2,584 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,472 |
3,128 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,040 |
2,033 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
183 |
$21K |
| D0274 |
Bitewings - four radiographic images |
676 |
670 |
$14K |
| D1206 |
Topical application of fluoride varnish |
573 |
573 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
141 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
95 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
36 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$988.00 |
| D1999 |
|
38 |
38 |
$0.00 |