| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
480 |
$17K |
| D0240 |
|
683 |
545 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
881 |
514 |
$9K |
| D1120 |
Prophylaxis - child |
454 |
448 |
$8K |
| D1206 |
Topical application of fluoride varnish |
509 |
501 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
568 |
562 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
197 |
195 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
120 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
24 |
$1K |
| D1351 |
Sealant - per tooth |
96 |
28 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$950.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$265.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$184.00 |