| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,552 |
3,517 |
$98K |
| D1120 |
Prophylaxis - child |
4,020 |
3,976 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,993 |
3,949 |
$83K |
| D9999 |
Unspecified adjunctive procedure, by report |
904 |
893 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,464 |
2,433 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,668 |
1,635 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
155 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
266 |
$6K |
| D1999 |
|
303 |
279 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,561 |
1,374 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$277.06 |