| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,557 |
1,451 |
$26K |
| D1120 |
Prophylaxis - child |
942 |
875 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,473 |
1,381 |
$19K |
| D1110 |
Prophylaxis - adult |
557 |
523 |
$18K |
| D0330 |
Panoramic radiographic image |
244 |
225 |
$9K |
| D0272 |
Bitewings - two radiographic images |
405 |
375 |
$6K |
| D0274 |
Bitewings - four radiographic images |
296 |
277 |
$5K |
| D1999 |
|
144 |
125 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
68 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
64 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
119 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
26 |
$696.00 |
| D1206 |
Topical application of fluoride varnish |
30 |
29 |
$522.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
25 |
$500.00 |