| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,355 |
3,188 |
$102K |
| D1120 |
Prophylaxis - child |
4,307 |
4,071 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,267 |
3,058 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,017 |
989 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
770 |
707 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,659 |
1,567 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
63 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,341 |
1,236 |
$10K |
| D1999 |
|
596 |
542 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
285 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,661 |
854 |
$4K |
| D0240 |
|
374 |
201 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
51 |
$1K |