| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,673 |
3,585 |
$105K |
| D1120 |
Prophylaxis - child |
4,292 |
4,188 |
$98K |
| D1206 |
Topical application of fluoride varnish |
4,496 |
4,363 |
$93K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,056 |
1,999 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
755 |
702 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,759 |
1,703 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
525 |
471 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,279 |
1,253 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
74 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
253 |
246 |
$10K |
| D1999 |
|
568 |
494 |
$7K |
| D1351 |
Sealant - per tooth |
184 |
44 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,332 |
1,280 |
$3K |
| D1354 |
|
617 |
176 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$200.94 |
| D0240 |
|
34 |
15 |
$196.02 |