| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,709 |
2,660 |
$77K |
| D1120 |
Prophylaxis - child |
3,145 |
3,079 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,529 |
2,464 |
$57K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,930 |
1,885 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
679 |
605 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
114 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
633 |
617 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
376 |
351 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
824 |
791 |
$6K |
| D0272 |
Bitewings - two radiographic images |
609 |
592 |
$6K |
| D1999 |
|
449 |
387 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
43 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
83 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
584 |
566 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$659.40 |