| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
810 |
802 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
331 |
157 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
358 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
83 |
$6K |
| D1999 |
|
128 |
125 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
51 |
$3K |
| D1120 |
Prophylaxis - child |
786 |
777 |
$574.43 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
256 |
233 |
$505.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$353.77 |
| D0272 |
Bitewings - two radiographic images |
141 |
141 |
$269.03 |
| D0230 |
Intraoral - periapical each additional radiographic image |
703 |
305 |
$159.00 |
| D0274 |
Bitewings - four radiographic images |
78 |
78 |
$151.00 |
| D0603 |
|
476 |
473 |
$8.00 |
| D1330 |
|
831 |
828 |
$3.00 |
| D1206 |
Topical application of fluoride varnish |
930 |
921 |
$0.00 |
| D9248 |
|
39 |
39 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
105 |
105 |
$0.00 |
| D0330 |
Panoramic radiographic image |
43 |
42 |
$0.00 |