| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,547 |
1,543 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,751 |
1,742 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,107 |
1,099 |
$17K |
| D9920 |
|
363 |
320 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
648 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
64 |
$10K |
| D1110 |
Prophylaxis - adult |
417 |
411 |
$8K |
| D0240 |
|
667 |
365 |
$7K |
| D0272 |
Bitewings - two radiographic images |
257 |
257 |
$5K |
| D9994 |
|
925 |
922 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
150 |
$1K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$945.52 |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
177 |
$733.28 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$657.90 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$466.44 |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
36 |
$92.34 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$0.00 |